Provider First Line Business Practice Location Address:
3138 W DAKOTA AVE SPC 137
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93722-4939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
558-248-1548
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2006