Provider First Line Business Practice Location Address:
1745 W AVENUE K
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-6502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-942-8437
Provider Business Practice Location Address Fax Number:
661-940-1959
Provider Enumeration Date:
01/23/2006