Provider First Line Business Practice Location Address:
24600 HART DR
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:
93561-8363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-821-6728
Provider Business Practice Location Address Fax Number:
661-821-3367
Provider Enumeration Date:
11/11/2006