Provider First Line Business Practice Location Address:
113 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:
93561-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-527-4146
Provider Business Practice Location Address Fax Number:
661-771-3163
Provider Enumeration Date:
11/17/2018