Provider First Line Business Practice Location Address:
434 S PLANO 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:
93257-5416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-784-0654
Provider Business Practice Location Address Fax Number:
559-784-4712
Provider Enumeration Date:
02/20/2007