Provider First Line Business Practice Location Address:
1064 LEWIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSBURG
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-897-2600
Provider Business Practice Location Address Fax Number:
559-897-2622
Provider Enumeration Date:
08/29/2008