Provider First Line Business Practice Location Address:
1600 16TH ST
Provider Second Line Business Practice Location Address:
(MO, 1-19,25-31,40)
Provider Business Practice Location Address City Name:
FIREBAUGH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93622-2407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-885-5580
Provider Business Practice Location Address Fax Number:
888-885-5580
Provider Enumeration Date:
02/07/2011