Provider First Line Business Practice Location Address:
100 OLD RIVER RD
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:
93311-8333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-855-7455
Provider Business Practice Location Address Fax Number:
559-334-3605
Provider Enumeration Date:
08/28/2025