Provider First Line Business Practice Location Address:
4700 BASQUE ST
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:
93313-2175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-378-5598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2025