Provider First Line Business Practice Location Address:
11856 1-8 BALBOA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANADA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-366-0001
Provider Business Practice Location Address Fax Number:
818-366-1755
Provider Enumeration Date:
04/26/2007