Provider First Line Business Practice Location Address:
12123 N RUSSELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FIREBAUGH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93622-9551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-707-3233
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2026