Provider First Line Business Practice Location Address:
22800 LYONS AVE
Provider Second Line Business Practice Location Address:
SUITE 200
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:
661-254-1884
Provider Business Practice Location Address Fax Number:
661-254-3655
Provider Enumeration Date:
04/16/2007