Provider First Line Business Practice Location Address:
18352 SOLEDAD CANYON ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-298-2700
Provider Business Practice Location Address Fax Number:
661-412-0233
Provider Enumeration Date:
06/17/2008