Provider First Line Business Practice Location Address:
24229 MAIN 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:
91321-2910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-259-2150
Provider Business Practice Location Address Fax Number:
661-259-6913
Provider Enumeration Date:
02/24/2009