Provider First Line Business Practice Location Address:
4221 ADIDAS 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:
93313-2404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-241-3233
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2021