Provider First Line Business Practice Location Address:
621 W LINE ST STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISHOP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93514-3320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-872-9153
Provider Business Practice Location Address Fax Number:
760-873-8007
Provider Enumeration Date:
11/02/2006