Provider First Line Business Practice Location Address:
18540 SOLEDAD CANYON RD SPC 134
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:
91351-7810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-723-0568
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2026