Provider First Line Business Practice Location Address:
40120 HIGHWAY 49
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
OAKHURST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93644-8957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-683-5100
Provider Business Practice Location Address Fax Number:
559-658-2333
Provider Enumeration Date:
12/20/2006