Provider First Line Business Practice Location Address:
2511 LOGAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93662-3012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-896-2624
Provider Business Practice Location Address Fax Number:
559-896-3235
Provider Enumeration Date:
06/29/2006