Provider First Line Business Practice Location Address:
1745 W AVENUE K
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-723-5400
Provider Business Practice Location Address Fax Number:
661-723-3944
Provider Enumeration Date:
03/25/2009