Provider First Line Business Practice Location Address:
13029 STOCKDALE HWY UNIT 40013029
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:
93314-9589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-679-3776
Provider Business Practice Location Address Fax Number:
661-932-3393
Provider Enumeration Date:
07/18/2025