Provider First Line Business Practice Location Address:
1220 W AVENUE K
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:
93534-5922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-723-2129
Provider Business Practice Location Address Fax Number:
661-949-9519
Provider Enumeration Date:
07/13/2006