Provider First Line Business Practice Location Address:
2731 NUGGET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ISABELLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-379-3412
Provider Business Practice Location Address Fax Number:
760-379-5332
Provider Enumeration Date:
08/11/2010