Provider First Line Business Practice Location Address:
14445 OLIVE VIEW DR
Provider Second Line Business Practice Location Address:
OLIVE VIEW HOSPITAL MED. CTR. ROOM # 2B 137
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-833-5646
Provider Business Practice Location Address Fax Number:
818-362-0293
Provider Enumeration Date:
11/15/2006