Provider First Line Business Practice Location Address:
4801 WILSON RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93309-4703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-832-1877
Provider Business Practice Location Address Fax Number:
661-832-7874
Provider Enumeration Date:
07/17/2006