Provider First Line Business Practice Location Address: 
2151 COLLEGE AVE.
    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: 
93305
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
661-868-8111
    Provider Business Practice Location Address Fax Number: 
661-868-8087
    Provider Enumeration Date: 
07/31/2014