Provider First Line Business Practice Location Address:
192 S. CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EARLIMART
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-849-2651
Provider Business Practice Location Address Fax Number:
661-849-1533
Provider Enumeration Date:
03/09/2026