Provider First Line Business Practice Location Address:
21282 CARRIAGE DR
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:
93561-6801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-822-4402
Provider Business Practice Location Address Fax Number:
661-823-3362
Provider Enumeration Date:
03/05/2013