Provider First Line Business Practice Location Address:
2101 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-758-5903
Provider Business Practice Location Address Fax Number:
661-758-6630
Provider Enumeration Date:
07/13/2006