Provider First Line Business Practice Location Address:
130 N VILLA 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:
93257-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-782-3090
Provider Business Practice Location Address Fax Number:
559-782-3097
Provider Enumeration Date:
10/19/2006