Provider First Line Business Practice Location Address:
12218 EDGECLIFF 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:
91342-5499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-572-6078
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2026