Provider First Line Business Practice Location Address:
646 W LANCASTER BLVD
Provider Second Line Business Practice Location Address:
SUITE #102
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-3127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-945-3418
Provider Business Practice Location Address Fax Number:
661-945-3495
Provider Enumeration Date:
12/07/2007