Provider First Line Business Practice Location Address:
1706 CHESTER AVE
Provider Second Line Business Practice Location Address:
SUITE 340
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93301-5242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-205-1522
Provider Business Practice Location Address Fax Number:
661-873-0515
Provider Enumeration Date:
07/20/2006