Provider First Line Business Practice Location Address:
1010 E AVENUE J
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:
93535-3840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-948-9620
Provider Business Practice Location Address Fax Number:
661-948-1309
Provider Enumeration Date:
08/22/2008