Provider First Line Business Practice Location Address:
38344 30TH STREET EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93550-4935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-273-1101
Provider Business Practice Location Address Fax Number:
661-273-2657
Provider Enumeration Date:
07/08/2006