Provider First Line Business Practice Location Address:
1601 E. PALMDALE BLVD
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:
93550-4840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-266-2887
Provider Business Practice Location Address Fax Number:
661-266-1162
Provider Enumeration Date:
10/02/2006