Provider First Line Business Practice Location Address:
23206 LYONS AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-2667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-288-2321
Provider Business Practice Location Address Fax Number:
661-288-0378
Provider Enumeration Date:
09/10/2007