Provider First Line Business Practice Location Address:
25101 THE OLD 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:
91381-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-249-9940
Provider Business Practice Location Address Fax Number:
661-418-5676
Provider Enumeration Date:
11/07/2013