Provider First Line Business Practice Location Address:
19900 PLUMMER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATSWORTH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91311-5541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
181-838-5684
Provider Business Practice Location Address Fax Number:
818-386-5600
Provider Enumeration Date:
01/03/2018