Provider First Line Business Practice Location Address:
743 W AVENUE I
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:
93534-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-726-9990
Provider Business Practice Location Address Fax Number:
661-726-7994
Provider Enumeration Date:
10/09/2006