Provider First Line Business Practice Location Address:
228 EAST KINGS ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVENAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93204-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-582-4481
Provider Business Practice Location Address Fax Number:
559-582-6547
Provider Enumeration Date:
02/19/2007