Provider First Line Business Practice Location Address:
6023 W AVENUE K2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93536-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-729-7020
Provider Business Practice Location Address Fax Number:
661-729-8644
Provider Enumeration Date:
01/17/2007