Provider First Line Business Practice Location Address:
200 S. MONTCLAIR STREET
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93309-0331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-835-7389
Provider Business Practice Location Address Fax Number:
661-835-0317
Provider Enumeration Date:
12/21/2009