Provider First Line Business Practice Location Address:
4801 WILSON RD STE C
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:
93309-4706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-885-9054
Provider Business Practice Location Address Fax Number:
661-836-5983
Provider Enumeration Date:
10/29/2006