Provider First Line Business Practice Location Address:
600 FAIRFAX RD APT 69
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:
93306-6871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-546-3566
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2022