Provider First Line Business Practice Location Address:
10515 LOUGHTON AVE
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:
93311-3528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-425-3603
Provider Business Practice Location Address Fax Number:
866-879-4941
Provider Enumeration Date:
07/14/2009