Provider First Line Business Practice Location Address:
144 BUENA VISTA DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERNVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-376-6504
Provider Business Practice Location Address Fax Number:
760-376-1625
Provider Enumeration Date:
02/21/2007