Provider First Line Business Practice Location Address:
2401 LAKE ST
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:
93306-5117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-706-8103
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2024