Provider First Line Business Practice Location Address: 
1415 N ACACIA AVE # 101
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
REEDLEY
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93654-2102
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
559-638-8187
    Provider Business Practice Location Address Fax Number: 
559-638-3883
    Provider Enumeration Date: 
12/14/2007