Provider First Line Business Practice Location Address:
16123 CHATSWORTH ST
Provider Second Line Business Practice Location Address:
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:
818-891-1745
Provider Business Practice Location Address Fax Number:
818-891-1747
Provider Enumeration Date:
11/01/2006