Provider First Line Business Practice Location Address:
2631 FASHION PL STE A
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:
93306-3067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-323-1111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2017