Provider First Line Business Practice Location Address:
1331 W AVENUE J
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-949-8882
Provider Business Practice Location Address Fax Number:
661-949-8686
Provider Enumeration Date:
07/18/2005