Provider First Line Business Practice Location Address:
349-A EAST AVENUE K-6
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:
93535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-723-4260
Provider Business Practice Location Address Fax Number:
661-723-6975
Provider Enumeration Date:
11/16/2006