Provider First Line Business Practice Location Address:
198 E ELM ST
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
COALINGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-935-2368
Provider Business Practice Location Address Fax Number:
559-935-2368
Provider Enumeration Date:
02/26/2007