Provider First Line Business Practice Location Address:
4817 CENTENNIAL PLAZA WAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-387-6700
Provider Business Practice Location Address Fax Number:
661-387-6511
Provider Enumeration Date:
06/28/2006