Provider First Line Business Practice Location Address:
24511 W. WAYNE AVE
Provider Second Line Business Practice Location Address:
COALINGA STATE HOSPITAL
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:
805-553-9356
Provider Business Practice Location Address Fax Number:
805-517-1231
Provider Enumeration Date:
04/25/2008