Provider First Line Business Practice Location Address:
13290 BRADLEY AVE
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:
91342-1203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-363-7687
Provider Business Practice Location Address Fax Number:
818-362-7837
Provider Enumeration Date:
10/22/2008