Provider First Line Business Practice Location Address:
122 S GREEN ST STE 5
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:
93561-1763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-750-2655
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2025