Provider First Line Business Practice Location Address:
42156 10TH ST W
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-7062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-510-7093
Provider Business Practice Location Address Fax Number:
661-794-2606
Provider Enumeration Date:
11/29/2006