Provider First Line Business Practice Location Address:
608 N 1ST AVE
Provider Second Line Business Practice Location Address:
ROOM 21
Provider Business Practice Location Address City Name:
AVENAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93204-1071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-221-8100
Provider Business Practice Location Address Fax Number:
559-221-8101
Provider Enumeration Date:
06/08/2009