Provider First Line Business Practice Location Address:
116 WEST E. 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-822-1004
Provider Business Practice Location Address Fax Number:
661-822-3603
Provider Enumeration Date:
11/21/2006