Provider First Line Business Practice Location Address:
42247 12TH STREET WEST
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-974-8009
Provider Business Practice Location Address Fax Number:
661-974-8305
Provider Enumeration Date:
01/04/2008