Provider First Line Business Practice Location Address:
217 W LOS ANGELES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORPARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93021-1867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-529-0100
Provider Business Practice Location Address Fax Number:
805-529-0102
Provider Enumeration Date:
10/15/2013