Provider First Line Business Practice Location Address:
380 N RESERVATION RD
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:
93257-9673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-784-2136
Provider Business Practice Location Address Fax Number:
559-781-6514
Provider Enumeration Date:
11/22/2005