Provider First Line Business Practice Location Address:
3753 E AVENUE I SPC 56
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:
93535-2471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-492-1199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2011