Provider First Line Business Practice Location Address:
2545 E AVENUE I SPC 3
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:
93535-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-974-2192
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2023