Provider First Line Business Practice Location Address:
7848 GENESTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE BALBOA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91406-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-574-5033
Provider Business Practice Location Address Fax Number:
818-574-5034
Provider Enumeration Date:
05/18/2026