Provider First Line Business Practice Location Address:
21726 PLACERITA CANYON 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:
91321-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-999-4935
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2022