Provider First Line Business Practice Location Address:
1351 W AVENUE J
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:
93534-2935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-942-1474
Provider Business Practice Location Address Fax Number:
661-723-0027
Provider Enumeration Date:
02/09/2007