Provider First Line Business Practice Location Address:
24303 WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-253-9555
Provider Business Practice Location Address Fax Number:
661-253-9556
Provider Enumeration Date:
06/19/2006