Provider First Line Business Practice Location Address:
2106 20TH 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:
93301-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-324-6053
Provider Business Practice Location Address Fax Number:
661-324-2640
Provider Enumeration Date:
09/05/2005