Provider First Line Business Practice Location Address:
23135 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CLARITA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-3611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-254-2269
Provider Business Practice Location Address Fax Number:
661-254-8532
Provider Enumeration Date:
11/21/2007