Provider First Line Business Practice Location Address:
1448 WASHINGTON 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:
93631-1931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-897-0112
Provider Business Practice Location Address Fax Number:
559-897-0112
Provider Enumeration Date:
10/09/2006