Provider First Line Business Practice Location Address:
3117 WILSON RD
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:
93304-5319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-324-4756
Provider Business Practice Location Address Fax Number:
661-617-2099
Provider Enumeration Date:
06/20/2008