Provider First Line Business Practice Location Address:
23450 NEWHALL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CLARITA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-3147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-405-2918
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2026