Provider First Line Business Practice Location Address:
23504 LYONS AVE
Provider Second Line Business Practice Location Address:
SUITE 101B
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-259-8010
Provider Business Practice Location Address Fax Number:
661-259-8793
Provider Enumeration Date:
11/03/2006