Provider First Line Business Practice Location Address:
142 SOUTH N STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULARE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93274-4212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-688-7406
Provider Business Practice Location Address Fax Number:
559-684-1296
Provider Enumeration Date:
10/12/2006