Provider First Line Business Practice Location Address:
4500 GOSFORD ROAD
Provider Second Line Business Practice Location Address:
UNIT 106
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93313-4840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-473-1800
Provider Business Practice Location Address Fax Number:
661-885-6088
Provider Enumeration Date:
11/01/2006