Provider First Line Business Practice Location Address:
12902 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-837-3818
Provider Business Practice Location Address Fax Number:
818-837-3820
Provider Enumeration Date:
07/19/2007