Provider First Line Business Practice Location Address:
530 KERN ST
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
TAFT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93268-2854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-703-0486
Provider Business Practice Location Address Fax Number:
661-763-4244
Provider Enumeration Date:
07/14/2006