Provider First Line Business Practice Location Address: 
860 W. SEVENTH ST.
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HANFORD
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93230-4926
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
559-585-7252
    Provider Business Practice Location Address Fax Number: 
559-585-7253
    Provider Enumeration Date: 
08/13/2009