Provider First Line Business Practice Location Address:
1654 W AVENUE J
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:
93534-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-948-2828
Provider Business Practice Location Address Fax Number:
661-948-5939
Provider Enumeration Date:
01/24/2007