Provider First Line Business Practice Location Address:
11111 ACADEMY 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:
93312-8641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-378-1255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2024