Provider First Line Business Practice Location Address:
1225 M. STREET
Provider Second Line Business Practice Location Address:
CORRECTIONAL HEALTH, 2ND FLOOR
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93721-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-442-2404
Provider Business Practice Location Address Fax Number:
559-442-5277
Provider Enumeration Date:
11/30/2005