Provider First Line Business Practice Location Address:
1629 WEST AVENUE J
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-942-3346
Provider Business Practice Location Address Fax Number:
661-942-0886
Provider Enumeration Date:
10/17/2006