Provider First Line Business Practice Location Address:
24100 SORREL COURT
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-822-9011
Provider Business Practice Location Address Fax Number:
661-822-0476
Provider Enumeration Date:
05/29/2007