Provider First Line Business Practice Location Address:
1011 E 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:
93535-3839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-945-5323
Provider Business Practice Location Address Fax Number:
661-945-3252
Provider Enumeration Date:
06/27/2006