Provider First Line Business Practice Location Address:
24359 WALNUT ST
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-255-2688
Provider Business Practice Location Address Fax Number:
661-255-0641
Provider Enumeration Date:
11/12/2009