Provider First Line Business Practice Location Address:
6570 W AVENUE L12
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:
93536-3807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-728-1500
Provider Business Practice Location Address Fax Number:
661-206-7526
Provider Enumeration Date:
09/04/2026