Provider First Line Business Practice Location Address:
5445 BALBOA BLVD
Provider Second Line Business Practice Location Address:
PHILLIPS GRADUATE INSTITUTE
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91316-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-386-5655
Provider Business Practice Location Address Fax Number:
818-386-5699
Provider Enumeration Date:
01/04/2007