Provider First Line Business Practice Location Address:
22368 S. 6TH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH DOS PALOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-447-0770
Provider Business Practice Location Address Fax Number:
559-268-1302
Provider Enumeration Date:
10/25/2007