Provider First Line Business Practice Location Address:
130 N BRAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FERNANDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91340-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-213-0581
Provider Business Practice Location Address Fax Number:
213-213-0580
Provider Enumeration Date:
05/10/2012