Provider First Line Business Practice Location Address:
400 TUCKER RD
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:
93561-0722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-822-2012
Provider Business Practice Location Address Fax Number:
661-822-2016
Provider Enumeration Date:
04/10/2019