Provider First Line Business Practice Location Address:
420 W. SHIELDS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93705-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-412-4702
Provider Business Practice Location Address Fax Number:
559-473-1475
Provider Enumeration Date:
11/30/2010