Provider First Line Business Practice Location Address:
21030 MISSION ST
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561-6769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-822-8979
Provider Business Practice Location Address Fax Number:
661-822-5729
Provider Enumeration Date:
01/17/2007