Provider First Line Business Practice Location Address:
44215 15TH STREET WEST
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-948-5723
Provider Business Practice Location Address Fax Number:
661-945-1095
Provider Enumeration Date:
07/21/2006