Provider First Line Business Practice Location Address:
9870 BRIMHALL RD UNIT 100
Provider Second Line Business Practice Location Address:
STE 303
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93312-2798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-587-7611
Provider Business Practice Location Address Fax Number:
661-587-7612
Provider Enumeration Date:
11/23/2005