Provider First Line Business Practice Location Address:
13652 CANTARA STREET
Provider Second Line Business Practice Location Address:
MEDICAL OFFICES BLDG 4 - PHARMACY CLINICAL OPERATIONS
Provider Business Practice Location Address City Name:
PANORAMA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-815-6039
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2011