Provider First Line Business Practice Location Address:
38700 5TH ST W STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93551-3996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-270-5253
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2026