Provider First Line Business Practice Location Address:
29700 GREENWATER 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-705-2054
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2012