Provider First Line Business Practice Location Address:
4133 W AVENUE J4
Provider Second Line Business Practice Location Address:
44750 60TH STREET WEST
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93536-6825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-729-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2013