Provider First Line Business Practice Location Address:
1817 W AVENUE K STE 207C
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:
93534-6423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-284-7136
Provider Business Practice Location Address Fax Number:
818-301-3255
Provider Enumeration Date:
12/15/2021