Provider First Line Business Practice Location Address:
7048 OWENSMOUTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANOGA PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91303-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-813-8013
Provider Business Practice Location Address Fax Number:
818-698-0418
Provider Enumeration Date:
09/02/2020