Provider First Line Business Practice Location Address:
220 N BALMAYNE 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:
93257-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-784-6655
Provider Business Practice Location Address Fax Number:
559-791-0805
Provider Enumeration Date:
05/21/2013