Provider First Line Business Practice Location Address: 
300 OLD RIVER RD STE 150
    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: 
93311-9512
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
661-301-7519
    Provider Business Practice Location Address Fax Number: 
661-491-3459
    Provider Enumeration Date: 
07/04/2006