Provider First Line Business Practice Location Address:
2416 CAMELLIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93280-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-900-3540
Provider Business Practice Location Address Fax Number:
661-405-2191
Provider Enumeration Date:
10/20/2025