Provider First Line Business Practice Location Address:
1220 OAK ST
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93304-1072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-324-0264
Provider Business Practice Location Address Fax Number:
800-507-1648
Provider Enumeration Date:
04/27/2010