Provider First Line Business Practice Location Address:
22924 LYONS AVE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-2757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-259-4910
Provider Business Practice Location Address Fax Number:
661-259-4904
Provider Enumeration Date:
12/17/2008