Provider First Line Business Practice Location Address:
798 TUCKER RD STE 1
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:
93561-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-206-8108
Provider Business Practice Location Address Fax Number:
661-821-9752
Provider Enumeration Date:
06/29/2006