Provider First Line Business Practice Location Address:
2509 MOUNT VERNON AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93306-2980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-215-8668
Provider Business Practice Location Address Fax Number:
661-679-4367
Provider Enumeration Date:
03/14/2016