Provider First Line Business Practice Location Address:
#1 KINGS WAY
Provider Second Line Business Practice Location Address:
AVENAL STATE PRISON
Provider Business Practice Location Address City Name:
AVENAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-386-6041
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006