Provider First Line Business Practice Location Address:
1672 W AVENUE J
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-885-8400
Provider Business Practice Location Address Fax Number:
818-885-5765
Provider Enumeration Date:
05/17/2006