Provider First Line Business Practice Location Address:
2141 HIGH ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SELMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93662-3047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-896-4455
Provider Business Practice Location Address Fax Number:
559-896-5421
Provider Enumeration Date:
07/31/2006