Provider First Line Business Practice Location Address:
23548 LYONS AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-5772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-254-3000
Provider Business Practice Location Address Fax Number:
661-630-4427
Provider Enumeration Date:
10/23/2008