Provider First Line Business Practice Location Address:
785 TUCKER RD STE F
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:
661-932-7001
Provider Business Practice Location Address Fax Number:
866-242-5109
Provider Enumeration Date:
08/12/2026