Provider First Line Business Practice Location Address:
6013 FAIRFAX RD APT D
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:
93306-7061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-345-3499
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2023