Provider First Line Business Practice Location Address:
10605 BALBOA BLVD
Provider Second Line Business Practice Location Address:
SUITE 330
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-832-7354
Provider Business Practice Location Address Fax Number:
818-832-7249
Provider Enumeration Date:
04/30/2007