Provider First Line Business Practice Location Address: 
560 E HERNDON AVE STE 201
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
FRESNO
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93720-2824
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
559-437-7311
    Provider Business Practice Location Address Fax Number: 
559-437-7152
    Provider Enumeration Date: 
06/13/2006