Provider First Line Business Practice Location Address:
20825 SOUTH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561-6438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-205-5373
Provider Business Practice Location Address Fax Number:
661-823-7483
Provider Enumeration Date:
07/05/2007