Provider First Line Business Practice Location Address:
228 E AVENUE H8
Provider Second Line Business Practice Location Address:
ROOM 101,102,103,104,105,106, AND CAFETERIA
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93535-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-776-1755
Provider Business Practice Location Address Fax Number:
818-776-1657
Provider Enumeration Date:
12/03/2008