Provider First Line Business Practice Location Address:
1141 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:
93534-7077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-802-4469
Provider Business Practice Location Address Fax Number:
661-802-4490
Provider Enumeration Date:
09/23/2011