Provider First Line Business Practice Location Address:
560 W PUTNAM AVE
Provider Second Line Business Practice Location Address:
NO 4
Provider Business Practice Location Address City Name:
PORTERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93257-3269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-782-1807
Provider Business Practice Location Address Fax Number:
559-782-4614
Provider Enumeration Date:
01/05/2007