Provider First Line Business Practice Location Address:
13207 FALL RIVER PL
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:
93314-6503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-317-5782
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2025