Provider First Line Business Practice Location Address:
4741 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
VALLEY VILLAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91607-3934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-985-6800
Provider Business Practice Location Address Fax Number:
818-985-6808
Provider Enumeration Date:
10/01/2008