Provider First Line Business Practice Location Address:
12227 SHADY HOLLOW LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTER RANCH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91326-3860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-675-4003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2026