Provider First Line Business Practice Location Address:
3240 ERSKINE CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ISABELLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93240-9608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-379-3651
Provider Business Practice Location Address Fax Number:
760-379-3812
Provider Enumeration Date:
12/27/2006