Provider First Line Business Practice Location Address:
16642 SOLEDAD CANYON RD
Provider Second Line Business Practice Location Address:
SAND CANYON SHOPPING CENTER
Provider Business Practice Location Address City Name:
CANYON COUNTRY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91387-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-252-5388
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006