Provider First Line Business Practice Location Address:
2041 LOS AMIGOS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA CANADA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91011-1363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-957-7647
Provider Business Practice Location Address Fax Number:
818-957-7691
Provider Enumeration Date:
04/28/2009