Provider First Line Business Practice Location Address:
14124 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-8049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-367-5939
Provider Business Practice Location Address Fax Number:
818-362-2179
Provider Enumeration Date:
03/20/2007