Provider First Line Business Practice Location Address:
150 E LERDO HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAFTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93263-2702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-746-4991
Provider Business Practice Location Address Fax Number:
661-746-5303
Provider Enumeration Date:
12/23/2011