Provider First Line Business Practice Location Address:
3401 COFFEE ROAD
Provider Second Line Business Practice Location Address:
SUITE #A
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93308-5080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-587-3512
Provider Business Practice Location Address Fax Number:
661-588-2587
Provider Enumeration Date:
08/23/2007