Provider First Line Business Practice Location Address:
3530 W MINERAL KING AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
NISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-625-2777
Provider Business Practice Location Address Fax Number:
559-625-3373
Provider Enumeration Date:
08/01/2006