Provider First Line Business Practice Location Address:
813 W AVENUE J
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:
93534-3426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-949-0700
Provider Business Practice Location Address Fax Number:
661-949-0701
Provider Enumeration Date:
01/29/2009