Provider First Line Business Practice Location Address:
23622 CALABASAS RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALABASAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91302-1584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-222-4543
Provider Business Practice Location Address Fax Number:
818-222-4547
Provider Enumeration Date:
08/04/2026