Provider First Line Business Practice Location Address:
1145 PHELPS AVENUE
Provider Second Line Business Practice Location Address:
# 104
Provider Business Practice Location Address City Name:
COALINGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-935-4374
Provider Business Practice Location Address Fax Number:
559-935-4316
Provider Enumeration Date:
08/26/2006