Provider First Line Business Practice Location Address:
306 DOUGLAS 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:
93308-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-333-1012
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2016