Provider First Line Business Practice Location Address:
777 W TEHACHAPI BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561-1686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-823-9144
Provider Business Practice Location Address Fax Number:
661-823-9144
Provider Enumeration Date:
10/04/2007