Provider First Line Business Practice Location Address:
43731 15TH ST W STE C
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:
93534-4785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-949-0120
Provider Business Practice Location Address Fax Number:
661-942-2370
Provider Enumeration Date:
10/11/2007