Provider First Line Business Practice Location Address:
1523 W AVENUE J
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-945-2221
Provider Business Practice Location Address Fax Number:
661-945-0831
Provider Enumeration Date:
12/26/2006