Provider First Line Business Practice Location Address:
12431 SAN FERNANDO RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-5080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-364-7177
Provider Business Practice Location Address Fax Number:
818-364-7477
Provider Enumeration Date:
03/30/2009