Provider First Line Business Practice Location Address:
831 W MORTON AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PORTERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93257-3184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-781-0633
Provider Business Practice Location Address Fax Number:
559-781-0633
Provider Enumeration Date:
05/06/2007