Provider First Line Business Practice Location Address:
1055 W MORTON AVE
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
PORTERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93257-1974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-283-6605
Provider Business Practice Location Address Fax Number:
559-793-1189
Provider Enumeration Date:
04/08/2011