Provider First Line Business Practice Location Address:
42011 4TH ST WEST
Provider Second Line Business Practice Location Address:
SUITE 1900 ANTELOPE VALLEY ADULT OFFICE
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-974-7600
Provider Business Practice Location Address Fax Number:
661-974-7054
Provider Enumeration Date:
12/07/2007