Provider First Line Business Practice Location Address:
43807 10TH STREET WEST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-4805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-942-5400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2006