Provider First Line Business Practice Location Address:
WASCO STATE PRISON
Provider Second Line Business Practice Location Address:
701 SCOFIELD AVENUE
Provider Business Practice Location Address City Name:
WASCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-758-8400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2016