Provider First Line Business Practice Location Address:
27013 LANGSIDE AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CLARITA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91351-2557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-424-0952
Provider Business Practice Location Address Fax Number:
661-424-0965
Provider Enumeration Date:
07/27/2006