Provider First Line Business Practice Location Address:
20241 W VALLEY BLVD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561-8746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-823-1473
Provider Business Practice Location Address Fax Number:
661-823-1475
Provider Enumeration Date:
03/08/2016