Provider First Line Business Practice Location Address:
5313 ROAD 39
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALPAUGH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93201-0273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-684-4530
Provider Business Practice Location Address Fax Number:
559-686-1157
Provider Enumeration Date:
02/18/2009