Provider First Line Business Practice Location Address:
14141 COVELLO ST
Provider Second Line Business Practice Location Address:
UNIT 9-C
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-787-1478
Provider Business Practice Location Address Fax Number:
818-781-7985
Provider Enumeration Date:
10/23/2009