Provider First Line Business Practice Location Address:
5904 CARISSA 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:
93309-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-377-9904
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2012