Provider First Line Business Practice Location Address:
41758 12TH ST W STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93551-1421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-723-3700
Provider Business Practice Location Address Fax Number:
661-723-3799
Provider Enumeration Date:
05/18/2010