Provider First Line Business Practice Location Address: 
7070 SCHIRRA CT STE 200
    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: 
93313-2122
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
661-834-7564
    Provider Business Practice Location Address Fax Number: 
661-831-8882
    Provider Enumeration Date: 
06/22/2016