Provider First Line Business Practice Location Address:
22330 SHERMAN WAY STE C3
Provider Second Line Business Practice Location Address:
STE C3
Provider Business Practice Location Address City Name:
CANOGA PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91303-1066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-348-6600
Provider Business Practice Location Address Fax Number:
818-348-0739
Provider Enumeration Date:
07/30/2006