Provider First Line Business Practice Location Address:
1101 O ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FIREBAUGH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93622-2224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-659-2159
Provider Business Practice Location Address Fax Number:
559-659-2985
Provider Enumeration Date:
11/15/2006