Provider First Line Business Practice Location Address:
210 WEST AVE J
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:
93534-3684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-723-3132
Provider Business Practice Location Address Fax Number:
661-723-1982
Provider Enumeration Date:
07/12/2006