Provider First Line Business Practice Location Address:
15107 VANOWEN ST
Provider Second Line Business Practice Location Address:
AMPUTATION PREVENTION CENTER - 4 EAST
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91405-4542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-902-5755
Provider Business Practice Location Address Fax Number:
818-904-3708
Provider Enumeration Date:
10/30/2012