Provider First Line Business Practice Location Address:
20601 HIGHWAY 202
Provider Second Line Business Practice Location Address:
UNIT A104
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-228-0590
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2020