Provider First Line Business Practice Location Address:
19700 PIEDRA 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:
93561-9450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-284-5663
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2025