Provider First Line Business Practice Location Address:
1305 HERZEL AVE
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:
93535-4380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-579-9657
Provider Business Practice Location Address Fax Number:
661-579-9565
Provider Enumeration Date:
09/30/2009