Provider First Line Business Practice Location Address:
500 OLD RIVER RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93311-9504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-664-0808
Provider Business Practice Location Address Fax Number:
800-691-2492
Provider Enumeration Date:
07/09/2006