Provider First Line Business Practice Location Address:
3106 OLD FARM ROAD
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:
93312-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-395-1835
Provider Business Practice Location Address Fax Number:
661-589-8311
Provider Enumeration Date:
09/20/2006