Provider First Line Business Practice Location Address:
23455 MARIPOSA AVE
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:
93561-8037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-343-2051
Provider Business Practice Location Address Fax Number:
661-422-3754
Provider Enumeration Date:
07/26/2022