Provider First Line Business Practice Location Address:
25078 PEACHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-2533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-799-3668
Provider Business Practice Location Address Fax Number:
661-799-3331
Provider Enumeration Date:
12/30/2005