Provider First Line Business Practice Location Address: 
937 FRANKLIN BLVD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
LEMOORE
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93246-4700
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
559-998-4384
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/27/2020