Provider First Line Business Practice Location Address: 
2302 MARTIN L KING JR BLVD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
FRESNO
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93706-4135
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
559-268-9559
    Provider Business Practice Location Address Fax Number: 
559-268-9500
    Provider Enumeration Date: 
04/08/2010