Provider First Line Business Practice Location Address:
10408 SOUTHPORT GLN
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:
93311-2915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-664-0790
Provider Business Practice Location Address Fax Number:
661-664-0790
Provider Enumeration Date:
01/29/2008