Provider First Line Business Practice Location Address:
19809 PRAIRIE ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATSWORTH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91311-6504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-308-3800
Provider Business Practice Location Address Fax Number:
818-450-0911
Provider Enumeration Date:
05/15/2012