Provider First Line Business Practice Location Address: 
5080 CALIFORNIA AVE STE 250
    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: 
93309-0732
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
661-258-3240
    Provider Business Practice Location Address Fax Number: 
855-568-2494
    Provider Enumeration Date: 
06/17/2024