Provider First Line Business Practice Location Address:
1505 W AVENUE J
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-729-6644
Provider Business Practice Location Address Fax Number:
661-729-6622
Provider Enumeration Date:
06/19/2007