Provider First Line Business Practice Location Address:
1419 SAN FERNANDO RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SAN FERNANDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91340-3229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-838-6120
Provider Business Practice Location Address Fax Number:
818-838-6121
Provider Enumeration Date:
12/04/2006