Provider First Line Business Practice Location Address:
5300 W AVENUE I
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:
93536-8312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-351-8903
Provider Business Practice Location Address Fax Number:
213-639-1361
Provider Enumeration Date:
10/07/2009