Provider First Line Business Practice Location Address:
774 N PROSPECT 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:
93257-1941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-783-9990
Provider Business Practice Location Address Fax Number:
559-783-9991
Provider Enumeration Date:
12/13/2005