Provider First Line Business Practice Location Address:
6253 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUJUNGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91042-2723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-236-2500
Provider Business Practice Location Address Fax Number:
818-236-2504
Provider Enumeration Date:
01/16/2007