Provider First Line Business Practice Location Address:
11 S TEILMAN AVE
Provider Second Line Business Practice Location Address:
RM 1, 2, 5, 12-18
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93706-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-221-8100
Provider Business Practice Location Address Fax Number:
559-221-8101
Provider Enumeration Date:
11/20/2007