Provider First Line Business Practice Location Address:
5300 W AVENUE I
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:
93536-8312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-940-4025
Provider Business Practice Location Address Fax Number:
661-940-4089
Provider Enumeration Date:
07/02/2007