Provider First Line Business Practice Location Address:
24511 WEST JAYNE AVE.
Provider Second Line Business Practice Location Address:
COALINGA STATE HOSPITAL
Provider Business Practice Location Address City Name:
COALINGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93210-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-934-3088
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2007