Provider First Line Business Practice Location Address:
148 E KINGS ST
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:
93204-1529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-386-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2014