Provider First Line Business Practice Location Address:
4201 CALIFORNIA AVE APT 44
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:
93309-1049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-111-1111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2014