Provider First Line Business Practice Location Address: 
10315 WOODLEY AVE STE 125
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
GRANADA HILLS
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
91344
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
818-378-9289
    Provider Business Practice Location Address Fax Number: 
818-688-3897
    Provider Enumeration Date: 
08/12/2009