Provider First Line Business Practice Location Address:
560 W PUTNAM AVE
Provider Second Line Business Practice Location Address:
SUITE 6
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:
559-781-7482
Provider Business Practice Location Address Fax Number:
559-781-8446
Provider Enumeration Date:
05/17/2006