Provider First Line Business Practice Location Address:
23450 NEWHALL AVE SPC 61
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CLARITA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-3138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-753-4224
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2020