Provider First Line Business Practice Location Address:
4829 PANAMA LN UNIT C
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:
93313-3482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-999-1501
Provider Business Practice Location Address Fax Number:
661-412-4495
Provider Enumeration Date:
01/22/2010