Provider First Line Business Practice Location Address: 
2550 W CLINTON AVE
    Provider Second Line Business Practice Location Address: 
BUILDINGS R, S, Y, D, P
    Provider Business Practice Location Address City Name: 
FRESNO
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93705
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
559-264-7521
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/20/2016