Provider First Line Business Practice Location Address:
418 W PUTNAM 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:
93257-3321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-784-4063
Provider Business Practice Location Address Fax Number:
559-784-2069
Provider Enumeration Date:
09/15/2005