Provider First Line Business Practice Location Address:
1150 E LERDO HWY
Provider Second Line Business Practice Location Address:
C
Provider Business Practice Location Address City Name:
SHAFTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93263-9419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-630-5890
Provider Business Practice Location Address Fax Number:
800-985-5309
Provider Enumeration Date:
07/19/2006