Provider First Line Business Practice Location Address:
1122 W AVENUE L12 STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-7051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-726-4200
Provider Business Practice Location Address Fax Number:
661-726-4241
Provider Enumeration Date:
10/04/2006