Provider First Line Business Practice Location Address:
557 W MORTON AVE
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:
93257-3383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-781-9922
Provider Business Practice Location Address Fax Number:
559-781-9925
Provider Enumeration Date:
02/28/2010