Provider First Line Business Practice Location Address:
12906 PROVIDENCE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93314-6543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-599-4264
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2007