Provider First Line Business Practice Location Address:
11177 TAMPA AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTER RANCH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91326-2254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-831-8000
Provider Business Practice Location Address Fax Number:
818-831-8005
Provider Enumeration Date:
01/14/2013