Provider First Line Business Practice Location Address:
412 W AVENUE J
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-3685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-729-4336
Provider Business Practice Location Address Fax Number:
661-723-7635
Provider Enumeration Date:
10/10/2008