Provider First Line Business Practice Location Address:
1817 W AVENUE K STE 211B
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:
93534-6421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-244-8210
Provider Business Practice Location Address Fax Number:
661-247-8444
Provider Enumeration Date:
02/18/2012