Provider First Line Business Practice Location Address:
566 W LANCASTER BLVD STE 19
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:
93534-2563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-579-6048
Provider Business Practice Location Address Fax Number:
661-200-7780
Provider Enumeration Date:
12/04/2012