Provider First Line Business Practice Location Address:
112 W IVY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANFORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93230-3820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-584-4439
Provider Business Practice Location Address Fax Number:
559-584-5802
Provider Enumeration Date:
03/15/2007