Provider First Line Business Practice Location Address:
14122 HUBBARD ST
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:
91342-4712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-361-0191
Provider Business Practice Location Address Fax Number:
818-387-1192
Provider Enumeration Date:
10/24/2005