Provider First Line Business Practice Location Address:
11272 OSBORNE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-7336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-573-4817
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2026