Provider First Line Business Practice Location Address:
38209 47TH ST E
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93552-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-272-3777
Provider Business Practice Location Address Fax Number:
661-272-9107
Provider Enumeration Date:
08/29/2005