Provider First Line Business Practice Location Address:
36654 SOUTH LASSEN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93234-1989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-945-7001
Provider Business Practice Location Address Fax Number:
559-945-7001
Provider Enumeration Date:
07/20/2006