Provider First Line Business Practice Location Address:
11541 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
SAN FERNANDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91340-4115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-365-5300
Provider Business Practice Location Address Fax Number:
818-365-2221
Provider Enumeration Date:
02/19/2008