Provider First Line Business Practice Location Address: 
2525 N CHESTER AVE STE C
    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: 
93308-1770
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
661-868-1850
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/12/2023