Provider First Line Business Practice Location Address:
212 GOODMAN ST
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:
93305-2904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-633-9753
Provider Business Practice Location Address Fax Number:
661-633-2447
Provider Enumeration Date:
08/16/2010