Provider First Line Business Practice Location Address:
1165 PHELPS AVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
COALINGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93210-9663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-935-5555
Provider Business Practice Location Address Fax Number:
559-935-2827
Provider Enumeration Date:
08/29/2006