Provider First Line Business Practice Location Address:
1524 27TH ST
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93301-2055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-716-9499
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2014