Provider First Line Business Practice Location Address:
840 TUCKER RD
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561-2564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-822-1333
Provider Business Practice Location Address Fax Number:
661-822-3313
Provider Enumeration Date:
01/22/2007