Provider First Line Business Practice Location Address:
1324 W AVENUE J STE 1
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:
93534-2948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-942-8777
Provider Business Practice Location Address Fax Number:
661-942-8795
Provider Enumeration Date:
02/27/2008