Provider First Line Business Practice Location Address:
1145 PHELPS AVE STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COALINGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93210-9443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-935-4374
Provider Business Practice Location Address Fax Number:
559-935-1900
Provider Enumeration Date:
03/05/2007