Provider First Line Business Practice Location Address:
3235 N SAN FERNANDO RD
Provider Second Line Business Practice Location Address:
UNIT # 6
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90065-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-550-5833
Provider Business Practice Location Address Fax Number:
818-550-1993
Provider Enumeration Date:
01/08/2009