Provider First Line Business Practice Location Address:
19943 LEMARSH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATSWORTH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91311-3516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-501-4263
Provider Business Practice Location Address Fax Number:
818-772-4318
Provider Enumeration Date:
01/22/2009