Provider First Line Business Practice Location Address:
14545 FRIAR ST
Provider Second Line Business Practice Location Address:
117
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91411-2397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-989-6381
Provider Business Practice Location Address Fax Number:
818-989-6382
Provider Enumeration Date:
01/09/2014