Provider First Line Business Practice Location Address:
20432 W VALLEY BLVD
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:
93561-8664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-823-9738
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2024