Provider First Line Business Practice Location Address:
23780 NEWHALL AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-3125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-689-4996
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2013