Provider First Line Business Practice Location Address:
251 E AVENUE K6 STE H
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:
93535-4513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-256-9557
Provider Business Practice Location Address Fax Number:
661-524-9898
Provider Enumeration Date:
01/21/2026