Provider First Line Business Practice Location Address:
1150 W MORTON AVE STE B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-782-1501
Provider Business Practice Location Address Fax Number:
559-782-8528
Provider Enumeration Date:
02/05/2007