Provider First Line Business Practice Location Address:
304 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:
93257-3211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-781-8829
Provider Business Practice Location Address Fax Number:
559-781-8863
Provider Enumeration Date:
01/17/2007