Provider First Line Business Practice Location Address: 
215 E CALDWELL AVE STE B
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
VISALIA
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93277
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
559-734-7035
    Provider Business Practice Location Address Fax Number: 
559-734-2890
    Provider Enumeration Date: 
08/05/2006