Provider First Line Business Practice Location Address:
1224 E AVENUE S
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93550-6180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-446-1221
Provider Business Practice Location Address Fax Number:
626-446-1121
Provider Enumeration Date:
09/12/2012