Provider First Line Business Practice Location Address:
5953 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
VALLEY VILLAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91607-5224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-744-0077
Provider Business Practice Location Address Fax Number:
424-652-2233
Provider Enumeration Date:
08/05/2007