Provider First Line Business Practice Location Address:
217 W KERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC FARLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93250-1360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-792-3038
Provider Business Practice Location Address Fax Number:
661-792-6270
Provider Enumeration Date:
08/15/2005