Provider First Line Business Practice Location Address:
1122 WEST AVENUE L12
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-942-2391
Provider Business Practice Location Address Fax Number:
661-723-3769
Provider Enumeration Date:
09/25/2006