Provider First Line Business Practice Location Address:
23502 LYONS AVE
Provider Second Line Business Practice Location Address:
SUITE 102
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:
661-222-7401
Provider Business Practice Location Address Fax Number:
661-964-0440
Provider Enumeration Date:
10/06/2006