Provider First Line Business Practice Location Address:
1522 18TH ST STE 213214
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:
93301-4448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-903-8825
Provider Business Practice Location Address Fax Number:
661-903-8862
Provider Enumeration Date:
01/25/2019