Provider First Line Business Practice Location Address:
1629 W AVENUE J
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-949-2290
Provider Business Practice Location Address Fax Number:
661-945-4754
Provider Enumeration Date:
02/21/2006