Provider First Line Business Practice Location Address:
6200 LAKE MING ROAD
Provider Second Line Business Practice Location Address:
SUITE A A-4
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-366-6079
Provider Business Practice Location Address Fax Number:
866-286-8360
Provider Enumeration Date:
01/23/2009