Provider First Line Business Practice Location Address:
7223 N. FAIR AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-432-4400
Provider Business Practice Location Address Fax Number:
818-764-7930
Provider Enumeration Date:
11/29/2007