Provider First Line Business Practice Location Address:
44830 VALLEY CENTRAL WAY
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93536-7207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-940-6060
Provider Business Practice Location Address Fax Number:
661-940-1616
Provider Enumeration Date:
12/29/2005