Provider First Line Business Practice Location Address:
3041 W AVENUE K
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:
93536-5402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-722-6300
Provider Business Practice Location Address Fax Number:
661-722-6450
Provider Enumeration Date:
11/28/2016