Provider First Line Business Practice Location Address:
12601 SAN FERNANDO RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-7733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-833-7000
Provider Business Practice Location Address Fax Number:
818-514-2447
Provider Enumeration Date:
07/27/2012