Provider First Line Business Practice Location Address:
1220 EAST AVENUE S
Provider Second Line Business Practice Location Address:
SUITE L
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-947-1288
Provider Business Practice Location Address Fax Number:
661-947-1844
Provider Enumeration Date:
03/23/2007