Provider First Line Business Practice Location Address:
23206 LYONS AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-2667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-255-1516
Provider Business Practice Location Address Fax Number:
551-255-1517
Provider Enumeration Date:
11/08/2006