Provider First Line Business Practice Location Address:
24332 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-789-5555
Provider Business Practice Location Address Fax Number:
818-789-7025
Provider Enumeration Date:
07/22/2008