Provider First Line Business Practice Location Address:
24239 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-799-7017
Provider Business Practice Location Address Fax Number:
661-799-7021
Provider Enumeration Date:
10/31/2012