Provider First Line Business Practice Location Address:
1024 4TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
TAFT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-754-2524
Provider Business Practice Location Address Fax Number:
661-765-6189
Provider Enumeration Date:
04/16/2010