Provider First Line Business Practice Location Address:
519 W SHIELDS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93705-4027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-244-0134
Provider Business Practice Location Address Fax Number:
559-244-0135
Provider Enumeration Date:
01/23/2010