Provider First Line Business Practice Location Address:
112 E F ST
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561-1740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-706-3465
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2013