Provider First Line Business Practice Location Address:
115 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:
93581-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-972-2874
Provider Business Practice Location Address Fax Number:
661-823-8106
Provider Enumeration Date:
02/23/2009