Provider First Line Business Practice Location Address:
1221 FULTON MALL
Provider Second Line Business Practice Location Address:
IMMUNIZATION CLINIC,1ST FLOOR
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93721-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-600-3281
Provider Business Practice Location Address Fax Number:
559-600-7726
Provider Enumeration Date:
10/23/2006