Provider First Line Business Practice Location Address:
12414 GILA RIVER DR
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:
93312-5740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-501-0165
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2020