Provider First Line Business Practice Location Address:
6424 DENSMORE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91406-6020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-568-9219
Provider Business Practice Location Address Fax Number:
818-798-1302
Provider Enumeration Date:
12/17/2025