Provider First Line Business Practice Location Address:
437 E LINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISHOP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93514-3505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-872-1117
Provider Business Practice Location Address Fax Number:
760-872-3898
Provider Enumeration Date:
03/21/2006