Provider First Line Business Practice Location Address:
93561
Provider Second Line Business Practice Location Address:
20111 W VALLEY BLVD
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-238-0600
Provider Business Practice Location Address Fax Number:
661-836-5088
Provider Enumeration Date:
05/11/2017