Provider First Line Business Practice Location Address:
14015 VAN NUYS BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ARLETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91331-4518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-890-2400
Provider Business Practice Location Address Fax Number:
818-890-0900
Provider Enumeration Date:
10/02/2007