Provider First Line Business Practice Location Address:
1605 E PALMDALE BLVD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93550-4882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-273-5333
Provider Business Practice Location Address Fax Number:
661-273-0033
Provider Enumeration Date:
11/14/2005