Provider First Line Business Practice Location Address:
2203 17TH 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:
93301-3634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-716-0333
Provider Business Practice Location Address Fax Number:
661-716-1288
Provider Enumeration Date:
02/01/2012