Provider First Line Business Practice Location Address:
43845 10TH ST W STE 2C
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:
93534-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-402-2221
Provider Business Practice Location Address Fax Number:
818-530-9287
Provider Enumeration Date:
10/02/2013