Provider First Line Business Practice Location Address:
1945 ACADEMY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULARE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93274-3185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-703-6856
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2007