Provider First Line Business Practice Location Address:
142 E TULARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAFTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93263-1834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-746-3844
Provider Business Practice Location Address Fax Number:
661-746-1243
Provider Enumeration Date:
03/19/2007