Provider First Line Business Practice Location Address:
459 W LINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISHOP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93514-3333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-873-4373
Provider Business Practice Location Address Fax Number:
760-873-3951
Provider Enumeration Date:
06/16/2009