Provider First Line Business Practice Location Address:
112 N D ST
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:
93257-3621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-783-0515
Provider Business Practice Location Address Fax Number:
559-783-0516
Provider Enumeration Date:
07/27/2005