Provider First Line Business Practice Location Address:
3022 W AVENUE L
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:
93536-4036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-722-8183
Provider Business Practice Location Address Fax Number:
661-722-7897
Provider Enumeration Date:
08/23/2005