Provider First Line Business Practice Location Address:
1220 E AVENUE S
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93550-6196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-267-6876
Provider Business Practice Location Address Fax Number:
661-267-0438
Provider Enumeration Date:
07/03/2006