Provider First Line Business Practice Location Address:
44469 10TH ST WEST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-945-9411
Provider Business Practice Location Address Fax Number:
661-945-7115
Provider Enumeration Date:
09/15/2006