Provider First Line Business Practice Location Address:
505 W MORTON AVE
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:
93257-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-782-8930
Provider Business Practice Location Address Fax Number:
559-782-1806
Provider Enumeration Date:
01/03/2013