Provider First Line Business Practice Location Address:
10324 BALBOA BLVD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANADA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91344-7349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-344-4474
Provider Business Practice Location Address Fax Number:
818-279-2804
Provider Enumeration Date:
09/14/2024