Provider First Line Business Practice Location Address:
1592 11TH ST
Provider Second Line Business Practice Location Address:
SUITE C2
Provider Business Practice Location Address City Name:
REEDLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-638-6099
Provider Business Practice Location Address Fax Number:
559-638-4685
Provider Enumeration Date:
09/23/2005