Provider First Line Business Practice Location Address:
1045 E ORANGE 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:
93257-5125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-782-7140
Provider Business Practice Location Address Fax Number:
559-788-0214
Provider Enumeration Date:
07/21/2026