Provider First Line Business Practice Location Address:
1501EAST AVENUE I
Provider Second Line Business Practice Location Address:
SPACE187
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-361-5852
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2008