Provider First Line Business Practice Location Address:
12631 LAVINA 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:
93312-6425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-815-1305
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2025