Provider First Line Business Practice Location Address:
11273 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FERNANDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-365-3978
Provider Business Practice Location Address Fax Number:
818-365-2769
Provider Enumeration Date:
10/03/2013