Provider First Line Business Practice Location Address:
590 W PUTNAM 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:
93257-3257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-781-3700
Provider Business Practice Location Address Fax Number:
559-781-1230
Provider Enumeration Date:
10/06/2014