Provider First Line Business Practice Location Address:
3612 COFFEE RD
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93308-5083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-587-7645
Provider Business Practice Location Address Fax Number:
661-587-7656
Provider Enumeration Date:
02/10/2009