Provider First Line Business Practice Location Address:
24534 PEACHLAND AVE
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:
91321-3457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-645-3150
Provider Business Practice Location Address Fax Number:
661-254-1227
Provider Enumeration Date:
02/27/2012