Provider First Line Business Practice Location Address:
11001 CHASE AVE
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:
93306-8316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-205-3774
Provider Business Practice Location Address Fax Number:
661-871-1270
Provider Enumeration Date:
09/20/2010