Provider First Line Business Practice Location Address:
583 WEST PUTNAM AVENUE
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:
93257-3260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-781-6655
Provider Business Practice Location Address Fax Number:
559-781-7876
Provider Enumeration Date:
12/19/2006