Provider First Line Business Practice Location Address:
1600 W AVENUE J
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:
93534-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-949-5000
Provider Business Practice Location Address Fax Number:
661-951-4327
Provider Enumeration Date:
07/11/2006