Provider First Line Business Practice Location Address:
1601 W AVENUE J
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-723-3131
Provider Business Practice Location Address Fax Number:
661-723-3112
Provider Enumeration Date:
12/15/2005