Provider First Line Business Practice Location Address:
3200 21ST ST STE 301
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:
93301-3108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-334-1958
Provider Business Practice Location Address Fax Number:
661-324-4095
Provider Enumeration Date:
07/29/2006