Provider First Line Business Practice Location Address:
27225 CAMP PLENTY RD
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
CANYON COUNTRY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91351-2654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-252-8802
Provider Business Practice Location Address Fax Number:
661-252-8597
Provider Enumeration Date:
07/03/2006