Provider First Line Business Practice Location Address:
24515 KANSAS ST
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:
91321-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-253-4971
Provider Business Practice Location Address Fax Number:
661-253-4972
Provider Enumeration Date:
11/03/2006