Provider First Line Business Practice Location Address:
20300 VALLEY BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561-8609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-822-1134
Provider Business Practice Location Address Fax Number:
661-822-1615
Provider Enumeration Date:
05/09/2007