Provider First Line Business Practice Location Address:
8879 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SUN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91352-2959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-252-2000
Provider Business Practice Location Address Fax Number:
818-252-6896
Provider Enumeration Date:
11/03/2009