Provider First Line Business Practice Location Address:
501 40TH ST
Provider Second Line Business Practice Location Address:
BLDG A
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93301-5845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-391-0305
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2015