Provider First Line Business Practice Location Address:
1201 24TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93301-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-579-3783
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2009