Provider First Line Business Practice Location Address:
7251 OWENSMOUTH AVE STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANOGA PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91303-3966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-281-0771
Provider Business Practice Location Address Fax Number:
818-281-0771
Provider Enumeration Date:
01/09/2026