Provider First Line Business Practice Location Address:
443 W MORTON AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
PORTERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93257-3352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-788-6340
Provider Business Practice Location Address Fax Number:
559-788-6344
Provider Enumeration Date:
11/02/2005