Provider First Line Business Practice Location Address:
610 E 18TH 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:
93305-5617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-555-5555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2016