Provider First Line Business Practice Location Address:
23550 LYONS AVE
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-284-5945
Provider Business Practice Location Address Fax Number:
661-284-7546
Provider Enumeration Date:
10/27/2006