Provider First Line Business Practice Location Address:
2045 N DICKENSON AVE
Provider Second Line Business Practice Location Address:
ROOMS 17, 19, MH, 32-34, 71-75, SO-A
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93723-9643
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:
01/08/2008