Provider First Line Business Practice Location Address:
13752 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-3193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-474-5750
Provider Business Practice Location Address Fax Number:
818-474-5740
Provider Enumeration Date:
10/07/2025