Provider First Line Business Practice Location Address:
27821 HALE CT
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:
93561-8350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-865-1327
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2007