Provider First Line Business Practice Location Address:
45030 3RD ST E
Provider Second Line Business Practice Location Address:
ROOM 09,10,15,16,17
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93535-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-776-1755
Provider Business Practice Location Address Fax Number:
818-776-1657
Provider Enumeration Date:
12/02/2008