Provider First Line Business Practice Location Address: 
3838 SAN DIMAS ST STE A200
    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: 
93301-1115
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
661-654-0200
    Provider Business Practice Location Address Fax Number: 
661-326-1633
    Provider Enumeration Date: 
04/13/2015