Provider First Line Business Practice Location Address:
14004 FREMANTLE CT
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:
93314-9298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-589-6661
Provider Business Practice Location Address Fax Number:
661-637-1112
Provider Enumeration Date:
07/27/2006