Provider First Line Business Practice Location Address:
2061 W AVENUE K
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:
93536-5234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-945-9699
Provider Business Practice Location Address Fax Number:
661-945-4259
Provider Enumeration Date:
01/19/2006