Provider First Line Business Practice Location Address:
1374 SMITH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSBURG
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93631-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-897-5801
Provider Business Practice Location Address Fax Number:
559-897-9134
Provider Enumeration Date:
08/26/2006