Provider First Line Business Practice Location Address:
14124 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-367-1012
Provider Business Practice Location Address Fax Number:
818-367-7570
Provider Enumeration Date:
10/13/2006