Provider First Line Business Practice Location Address:
24625 ARCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-1111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-288-2644
Provider Business Practice Location Address Fax Number:
661-288-1669
Provider Enumeration Date:
11/07/2006