Provider First Line Business Practice Location Address:
42220 10TH ST W
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-7075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-729-4231
Provider Business Practice Location Address Fax Number:
661-940-3041
Provider Enumeration Date:
08/20/2006