Provider First Line Business Practice Location Address:
10445 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PACOIMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91331-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-890-8070
Provider Business Practice Location Address Fax Number:
818-890-1474
Provider Enumeration Date:
12/28/2006