Provider First Line Business Practice Location Address:
40050 HIGHWAY 49 STE N3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKHURST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93644-8878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-642-2500
Provider Business Practice Location Address Fax Number:
559-642-2888
Provider Enumeration Date:
07/19/2006