Provider First Line Business Practice Location Address:
130 N VILLA ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PORTERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93257-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-781-4500
Provider Business Practice Location Address Fax Number:
559-781-4502
Provider Enumeration Date:
02/28/2006