Provider First Line Business Practice Location Address:
44439 17TH ST. W
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-949-0390
Provider Business Practice Location Address Fax Number:
661-948-7040
Provider Enumeration Date:
01/17/2007