Provider First Line Business Practice Location Address:
20717 SOUTH ST STE D
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:
93561-6444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-300-8257
Provider Business Practice Location Address Fax Number:
661-402-6503
Provider Enumeration Date:
12/22/2022