Provider First Line Business Practice Location Address:
1370 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
LACANADA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-952-6193
Provider Business Practice Location Address Fax Number:
818-952-6189
Provider Enumeration Date:
07/31/2006