Provider First Line Business Practice Location Address:
1711 30TH 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:
93301-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-325-7251
Provider Business Practice Location Address Fax Number:
661-325-6412
Provider Enumeration Date:
09/22/2006