Provider First Line Business Practice Location Address:
41250 12TH ST W STE C
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:
93551-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-224-1300
Provider Business Practice Location Address Fax Number:
661-224-1333
Provider Enumeration Date:
02/13/2015