Provider First Line Business Practice Location Address:
11273 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FERNANDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91340-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-349-1045
Provider Business Practice Location Address Fax Number:
818-361-7727
Provider Enumeration Date:
01/24/2007