Provider First Line Business Practice Location Address:
1745 W AVENUE K
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-656-9111
Provider Business Practice Location Address Fax Number:
323-650-9669
Provider Enumeration Date:
07/27/2007