Provider First Line Business Practice Location Address:
1107 W POPLAR AVE
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:
93257-5839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-781-7242
Provider Business Practice Location Address Fax Number:
559-793-3574
Provider Enumeration Date:
09/01/2011