Provider First Line Business Practice Location Address:
1125 E LASSEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVENAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93204-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-836-2856
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2009