Provider First Line Business Practice Location Address:
661 N PROSPECT 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:
93257-1938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-853-4585
Provider Business Practice Location Address Fax Number:
559-853-4586
Provider Enumeration Date:
09/26/2020