Provider First Line Business Practice Location Address:
198 W CHERRY AVE
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
PORTERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93257-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-781-7980
Provider Business Practice Location Address Fax Number:
559-788-0544
Provider Enumeration Date:
10/25/2006