Provider First Line Business Practice Location Address:
1300 SCARLET OAK 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:
93561-2458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-823-3339
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2009