Provider First Line Business Practice Location Address:
23928 LYONS AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-255-8320
Provider Business Practice Location Address Fax Number:
661-255-0338
Provider Enumeration Date:
08/31/2006