Provider First Line Business Practice Location Address:
19803 ELLIS HENRY CT
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:
91321-2185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-554-8348
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2026