Provider First Line Business Practice Location Address:
14315 MOORPARK ST
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91423-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-395-6144
Provider Business Practice Location Address Fax Number:
818-849-5063
Provider Enumeration Date:
12/11/2007