Provider First Line Business Practice Location Address:
11143 ALLEGHENY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91352-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-219-6773
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2026