Provider First Line Business Practice Location Address:
560 W PUTNAM AVE
Provider Second Line Business Practice Location Address:
#5
Provider Business Practice Location Address City Name:
PORTERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-781-4007
Provider Business Practice Location Address Fax Number:
559-783-9454
Provider Enumeration Date:
09/12/2006