Provider First Line Business Practice Location Address:
43535 GADSDEN AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-6147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-942-6522
Provider Business Practice Location Address Fax Number:
661-942-2677
Provider Enumeration Date:
03/08/2007