Provider First Line Business Practice Location Address:
15783 18TH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEMOORE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-924-3405
Provider Business Practice Location Address Fax Number:
559-925-1153
Provider Enumeration Date:
12/26/2006