Provider First Line Business Practice Location Address:
402 E F ST
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:
93561-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-341-6133
Provider Business Practice Location Address Fax Number:
661-401-5514
Provider Enumeration Date:
03/15/2013