Provider First Line Business Practice Location Address:
38660 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE A350
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93551-4385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-951-9519
Provider Business Practice Location Address Fax Number:
661-948-6909
Provider Enumeration Date:
02/15/2007