Provider First Line Business Practice Location Address:
4819 CALLOWAY DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-858-3846
Provider Business Practice Location Address Fax Number:
661-825-8170
Provider Enumeration Date:
01/14/2013