Provider First Line Business Practice Location Address:
21211 LEMARSH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATSWORTH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91311-3016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-709-7179
Provider Business Practice Location Address Fax Number:
818-709-4195
Provider Enumeration Date:
12/31/2008