Provider First Line Business Practice Location Address: 
2737 W CECIL AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
DELANO
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93215
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
661-721-2345
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/05/2012