Provider First Line Business Practice Location Address:
21633 AVENUE 24 BLDG 1101 RM 173
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHOWCHILLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93610-0099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-665-6100
Provider Business Practice Location Address Fax Number:
559-665-6878
Provider Enumeration Date:
03/12/2020