Provider First Line Business Practice Location Address:
412 W AVENUE J
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-3685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-770-6022
Provider Business Practice Location Address Fax Number:
949-770-7084
Provider Enumeration Date:
01/25/2010