Provider First Line Business Practice Location Address:
827 E AVENUE Q9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93550-4732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-273-5160
Provider Business Practice Location Address Fax Number:
661-273-5161
Provider Enumeration Date:
11/29/2006