Provider First Line Business Practice Location Address:
55 W LOS ANGELES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORPARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93021-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-523-3216
Provider Business Practice Location Address Fax Number:
805-523-9630
Provider Enumeration Date:
07/10/2006