Provider First Line Business Practice Location Address:
10504 MIDGE DR
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:
93314-8173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-447-6692
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2025