Provider First Line Business Practice Location Address:
1059 E LINGARD ST
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:
93535-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-942-3615
Provider Business Practice Location Address Fax Number:
661-949-8474
Provider Enumeration Date:
11/20/2007