Provider First Line Business Practice Location Address:
432 S MILL ST
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:
93561-2027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-823-2273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2006