Provider First Line Business Practice Location Address:
25059 PEACHLAND AVE
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:
91321-2517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-255-1555
Provider Business Practice Location Address Fax Number:
661-255-6369
Provider Enumeration Date:
11/14/2006