Provider First Line Business Practice Location Address:
5509 YOUNG ST
Provider Second Line Business Practice Location Address:
CAL DEPT CORRECTIONS & REHAB DCHCS REGIONIII DENTAL
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93311-9648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-708-6306
Provider Business Practice Location Address Fax Number:
661-664-2563
Provider Enumeration Date:
09/07/2006