Provider First Line Business Practice Location Address:
13048 ANGELES TRAIL WAY
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:
91342-3479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-497-1933
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2026