Provider First Line Business Practice Location Address:
1217 E PONDERA ST
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:
93535-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-554-5284
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2026