Provider First Line Business Practice Location Address:
1224 E AVENUE S
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93550-6180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-274-8666
Provider Business Practice Location Address Fax Number:
661-274-9108
Provider Enumeration Date:
06/08/2006