Provider First Line Business Practice Location Address:
407 BALSAM AVE
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:
93305-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-410-5439
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2026