Provider First Line Business Practice Location Address:
43403 10TH ST W STE C
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:
93534-6039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-723-6824
Provider Business Practice Location Address Fax Number:
661-723-5369
Provider Enumeration Date:
05/27/2009