Provider First Line Business Practice Location Address:
1921 18TH STREET
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:
93301-4205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-324-1045
Provider Business Practice Location Address Fax Number:
661-324-1045
Provider Enumeration Date:
08/17/2006