Provider First Line Business Practice Location Address:
1759 W AVENUE J
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-942-6400
Provider Business Practice Location Address Fax Number:
661-729-3985
Provider Enumeration Date:
12/27/2007