Provider First Line Business Practice Location Address:
15520 BLACK HAWK 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:
93314-7844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-589-4114
Provider Business Practice Location Address Fax Number:
661-589-7293
Provider Enumeration Date:
05/25/2006