Provider First Line Business Practice Location Address:
335 E AVENUE I RM # 2D07, 2D09
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-738-3111
Provider Business Practice Location Address Fax Number:
213-386-5282
Provider Enumeration Date:
04/25/2011