Provider First Line Business Practice Location Address:
3723 E DAKOTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93726-5106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-709-9169
Provider Business Practice Location Address Fax Number:
559-225-5369
Provider Enumeration Date:
12/08/2006