Provider First Line Business Practice Location Address:
1430 S GREEN ST
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:
93561-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-300-0028
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2010