Provider First Line Business Practice Location Address:
1331 W AVENUE J STE 202
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-529-7550
Provider Business Practice Location Address Fax Number:
661-529-7560
Provider Enumeration Date:
10/02/2006