Provider First Line Business Practice Location Address:
144 W LOS ANGELES AVE
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
MOORPARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93021-1898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-553-1980
Provider Business Practice Location Address Fax Number:
805-553-1981
Provider Enumeration Date:
11/19/2008