Provider First Line Business Practice Location Address:
9802 STOCKDALE HWY
Provider Second Line Business Practice Location Address:
SUITE 106 A
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93311-3652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-663-8674
Provider Business Practice Location Address Fax Number:
661-847-9613
Provider Enumeration Date:
08/29/2012