Provider First Line Business Practice Location Address:
1412 17TH ST STE 555
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:
93301-5218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-472-9673
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2019