Provider First Line Business Practice Location Address:
820 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAFT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93268-2306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-763-1521
Provider Business Practice Location Address Fax Number:
661-763-1495
Provider Enumeration Date:
02/12/2007