Provider First Line Business Practice Location Address:
27225 CAMP PLENTY RD
Provider Second Line Business Practice Location Address:
SUITE 9
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-251-4672
Provider Business Practice Location Address Fax Number:
661-251-0348
Provider Enumeration Date:
01/24/2007