Provider First Line Business Practice Location Address:
159 N CLARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93701-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-266-5882
Provider Business Practice Location Address Fax Number:
559-266-8311
Provider Enumeration Date:
11/22/2005