Provider First Line Business Practice Location Address:
14445 OLIVE VIEW DRIVE
Provider Second Line Business Practice Location Address:
OLD LAB BUILDING
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-364-3611
Provider Business Practice Location Address Fax Number:
818-364-3322
Provider Enumeration Date:
11/04/2006