Provider First Line Business Practice Location Address:
140 S C STREET
Provider Second Line Business Practice Location Address:
856 N RED OAK STREET
Provider Business Practice Location Address City Name:
PORTERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93257-4822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-789-7170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2023