Provider First Line Business Practice Location Address:
28125 BAKERTON AVE
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:
91351-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-445-9195
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2026