Provider First Line Business Practice Location Address:
22621 LYONS AVE
Provider Second Line Business Practice Location Address:
205
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-287-9337
Provider Business Practice Location Address Fax Number:
661-253-4164
Provider Enumeration Date:
10/20/2006