Provider First Line Business Practice Location Address:
223 BASSETT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KING CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93930-2942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-385-5945
Provider Business Practice Location Address Fax Number:
831-385-0767
Provider Enumeration Date:
02/12/2007