Provider First Line Business Practice Location Address:
4711 HIGHWAY 166
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CUYAMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-766-2558
Provider Business Practice Location Address Fax Number:
661-766-2376
Provider Enumeration Date:
09/28/2006