Provider First Line Business Practice Location Address:
38733 9TH ST EAST
Provider Second Line Business Practice Location Address:
STE O-#5
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-947-4193
Provider Business Practice Location Address Fax Number:
661-949-6804
Provider Enumeration Date:
06/05/2007