Provider First Line Business Practice Location Address:
1522 18TH ST STE 207
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:
93301-4432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-791-7167
Provider Business Practice Location Address Fax Number:
339-707-9017
Provider Enumeration Date:
09/16/2019