Provider First Line Business Practice Location Address:
44806 ELM AVE
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:
661-948-1917
Provider Business Practice Location Address Fax Number:
661-951-7786
Provider Enumeration Date:
10/15/2010