Provider First Line Business Practice Location Address:
512 W LINE ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BISHOP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93514-3347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-873-7230
Provider Business Practice Location Address Fax Number:
760-872-3418
Provider Enumeration Date:
07/27/2006