Provider First Line Business Practice Location Address:
24480 MAIN ST STE 110
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:
91321-2873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-505-7133
Provider Business Practice Location Address Fax Number:
661-200-3707
Provider Enumeration Date:
09/26/2006