Provider First Line Business Practice Location Address:
141 N. CLARK STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93701-2124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-528-0565
Provider Business Practice Location Address Fax Number:
559-528-0567
Provider Enumeration Date:
04/11/2007