Provider First Line Business Practice Location Address:
1345 W AVE P
Provider Second Line Business Practice Location Address:
ANTELOPE VALLEY MALL
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93551-3182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-273-3958
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2006