Provider First Line Business Practice Location Address:
1 KINGS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVENAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
558-386-0587
Provider Business Practice Location Address Fax Number:
559-386-7067
Provider Enumeration Date:
07/17/2009