Provider First Line Business Practice Location Address:
38440 5TH ST W STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93551-4499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-214-7718
Provider Business Practice Location Address Fax Number:
661-214-7719
Provider Enumeration Date:
12/28/2011