Provider First Line Business Practice Location Address:
1367 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA CANADA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91011-2183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-766-5376
Provider Business Practice Location Address Fax Number:
818-766-9736
Provider Enumeration Date:
10/26/2006