Provider First Line Business Practice Location Address:
5540 KERN VALLEY PLAZA
Provider Second Line Business Practice Location Address:
LAKE ISABELLA BLVD
Provider Business Practice Location Address City Name:
LAKE ISABELLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-417-2068
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2008