Provider First Line Business Practice Location Address:
23548 LYONS AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-5782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-414-2350
Provider Business Practice Location Address Fax Number:
661-513-4991
Provider Enumeration Date:
12/15/2010