Provider First Line Business Practice Location Address:
830 W AVENUE L STE 129
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:
93534-7210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-280-0012
Provider Business Practice Location Address Fax Number:
661-951-1961
Provider Enumeration Date:
04/09/2007