Provider First Line Business Practice Location Address:
113 E F ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-301-7745
Provider Business Practice Location Address Fax Number:
661-214-3180
Provider Enumeration Date:
06/18/2007