Provider First Line Business Practice Location Address:
2317 17TH STREET
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:
93301-3503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-323-5484
Provider Business Practice Location Address Fax Number:
661-323-9160
Provider Enumeration Date:
11/29/2006