Provider First Line Business Practice Location Address:
174 N VILLA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93257-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-781-6960
Provider Business Practice Location Address Fax Number:
559-781-6996
Provider Enumeration Date:
07/12/2007