Provider First Line Business Practice Location Address:
121 W KERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC FARLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93250-1348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-808-0576
Provider Business Practice Location Address Fax Number:
661-792-4041
Provider Enumeration Date:
02/10/2012