Provider First Line Business Practice Location Address:
1345 W BUSH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEMOORE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93245-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-924-3175
Provider Business Practice Location Address Fax Number:
559-924-2485
Provider Enumeration Date:
01/12/2011