Provider First Line Business Practice Location Address: 
16111 PLUMMER ST.
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
NORTH HILLS
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
91343
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
818-891-7711
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/25/2006