Provider First Line Business Practice Location Address:
1815 COUNTRY CLUB DR
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:
93306-3807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-204-9512
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2026