Provider First Line Business Practice Location Address:
11273 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
SUITE#3
Provider Business Practice Location Address City Name:
SAN FERNANDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91340-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-365-7191
Provider Business Practice Location Address Fax Number:
818-361-7641
Provider Enumeration Date:
01/08/2007