Provider First Line Business Practice Location Address:
121 E MERCED ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FOWLER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93625-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-316-7053
Provider Business Practice Location Address Fax Number:
559-316-7054
Provider Enumeration Date:
09/14/2006