Provider First Line Business Practice Location Address:
105W E 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:
93561-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-823-7070
Provider Business Practice Location Address Fax Number:
661-823-0235
Provider Enumeration Date:
03/30/2006