Provider First Line Business Practice Location Address:
2207 MACAU ST
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:
93313-5588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-327-7504
Provider Business Practice Location Address Fax Number:
866-788-9917
Provider Enumeration Date:
04/25/2017