Provider First Line Business Practice Location Address:
6548 COLBATH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91401-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-398-7090
Provider Business Practice Location Address Fax Number:
818-904-2545
Provider Enumeration Date:
05/01/2007