Provider First Line Business Practice Location Address:
17808 LUDLOW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANADA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91344-4522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-329-2197
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2026