Provider First Line Business Practice Location Address:
18520 SOLEDAD CANYON RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
CANYON COUNTRY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91351-3775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-298-9500
Provider Business Practice Location Address Fax Number:
661-250-0323
Provider Enumeration Date:
06/23/2006