Provider First Line Business Practice Location Address:
3612 COFFEE RD # A
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:
93308-5027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-391-9393
Provider Business Practice Location Address Fax Number:
661-589-9359
Provider Enumeration Date:
12/13/2006