Provider First Line Business Practice Location Address:
42230 LAKE HUGHES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE HUGHES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93532-1012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-297-1578
Provider Business Practice Location Address Fax Number:
661-296-3595
Provider Enumeration Date:
12/15/2010