Provider First Line Business Practice Location Address:
17909 SOLEDAD CANYON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANYON COUNTRY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91387-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-250-5220
Provider Business Practice Location Address Fax Number:
661-250-5243
Provider Enumeration Date:
10/21/2005