Provider First Line Business Practice Location Address:
42011 4TH STREET WEST
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:
93534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-974-7074
Provider Business Practice Location Address Fax Number:
611-974-7055
Provider Enumeration Date:
12/07/2007