Provider First Line Business Practice Location Address:
20242 W VALLEY BLVD
Provider Second Line Business Practice Location Address:
STE E
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:
661-606-4888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2020