Provider First Line Business Practice Location Address:
1720 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:
93534-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-952-1100
Provider Business Practice Location Address Fax Number:
661-952-1103
Provider Enumeration Date:
10/13/2006