Provider First Line Business Practice Location Address:
512 W. LINE STREET
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BISHOP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-587-2700
Provider Business Practice Location Address Fax Number:
559-236-3422
Provider Enumeration Date:
07/12/2019