Provider First Line Business Practice Location Address:
148 E KINGS ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVENAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93204-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-386-8865
Provider Business Practice Location Address Fax Number:
559-386-0550
Provider Enumeration Date:
06/05/2026