Provider First Line Business Practice Location Address:
19310 AVENUE OF THE OAKS
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:
91321-1476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-251-0700
Provider Business Practice Location Address Fax Number:
661-775-8311
Provider Enumeration Date:
08/20/2019