Provider First Line Business Practice Location Address:
614 DOUGLAS ST APT D
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:
93308-2392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-331-7773
Provider Business Practice Location Address Fax Number:
559-432-2349
Provider Enumeration Date:
06/12/2014