Provider First Line Business Practice Location Address:
25236 RUNNING HORSE RD
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:
91321-3336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-679-4613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2022