Provider First Line Business Practice Location Address:
8200 STOCKDALE HWY
Provider Second Line Business Practice Location Address:
SUITE M10-166 TOWN AND COUNTRY VILLAGE
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-305-8065
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2013