Provider First Line Business Practice Location Address: 
201 N COURT ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
VISALIA
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93291-4918
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
559-627-2046
    Provider Business Practice Location Address Fax Number: 
559-627-9079
    Provider Enumeration Date: 
11/14/2006