Provider First Line Business Practice Location Address:
1405 COMMERCIAL WAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93309-0620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-428-1567
Provider Business Practice Location Address Fax Number:
800-862-2668
Provider Enumeration Date:
01/28/2017