Provider First Line Business Practice Location Address:
3200 21ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93301-4452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-871-1081
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2006