Provider First Line Business Practice Location Address:
11165 SEPULVEDA BLVD
Provider Second Line Business Practice Location Address:
SPA BLDG., PT DEP'T
Provider Business Practice Location Address City Name:
MISSION HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91345-1113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-837-5732
Provider Business Practice Location Address Fax Number:
818-837-2709
Provider Enumeration Date:
04/21/2011