Provider First Line Business Practice Location Address:
4033 W. AVE L
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-722-0861
Provider Business Practice Location Address Fax Number:
661-722-1931
Provider Enumeration Date:
11/02/2010