Provider First Line Business Practice Location Address:
4124 ARDMORE 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:
93309-4982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-889-2747
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2014