Provider First Line Business Practice Location Address:
4549 HASKELL AVE
Provider Second Line Business Practice Location Address:
4
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-986-7460
Provider Business Practice Location Address Fax Number:
818-285-4224
Provider Enumeration Date:
03/28/2012