Provider First Line Business Practice Location Address:
317 E KINGS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVENAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93204-1630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-583-1480
Provider Business Practice Location Address Fax Number:
559-583-1475
Provider Enumeration Date:
12/22/2018