Provider First Line Business Practice Location Address:
24264 SAN FERNANDO RD
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:
91321-2911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-290-2825
Provider Business Practice Location Address Fax Number:
661-290-2864
Provider Enumeration Date:
11/09/2006