Provider First Line Business Practice Location Address:
701 SCOFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93280-7515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-758-8400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2014