Provider First Line Business Practice Location Address:
1817 W AVENUE K
Provider Second Line Business Practice Location Address:
STE 207
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-6423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-400-2342
Provider Business Practice Location Address Fax Number:
661-793-7289
Provider Enumeration Date:
08/09/2006