Provider First Line Business Practice Location Address:
1669 W AVENUE J
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-723-3244
Provider Business Practice Location Address Fax Number:
661-723-3504
Provider Enumeration Date:
11/23/2005