Provider First Line Business Practice Location Address:
161 MILL STREET
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:
93561-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-822-9054
Provider Business Practice Location Address Fax Number:
661-822-9082
Provider Enumeration Date:
03/26/2008