Provider First Line Business Practice Location Address:
724 MEDICAL CENTER DR E
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93611-6811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-323-4495
Provider Business Practice Location Address Fax Number:
559-323-4498
Provider Enumeration Date:
10/26/2005