Provider First Line Business Practice Location Address:
10515 BALBOA BLVD.
Provider Second Line Business Practice Location Address:
SUITE 140
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:
818-363-0339
Provider Business Practice Location Address Fax Number:
818-363-9915
Provider Enumeration Date:
02/13/2007