Provider First Line Business Practice Location Address:
661 W POPLAR 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:
93257-5926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-784-8371
Provider Business Practice Location Address Fax Number:
559-784-0101
Provider Enumeration Date:
07/21/2014