Provider First Line Business Practice Location Address:
20705 SOUTH ST STE F
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:
93561-8650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-473-3473
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2006