Provider First Line Business Practice Location Address:
16711 LAHEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANADA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91344-4212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-326-8426
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2023