Provider First Line Business Practice Location Address:
24876 APPLE ST STE C
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:
91321-2683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-292-8899
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2023