Provider First Line Business Practice Location Address:
6800 OWENSMOUTH AVE
Provider Second Line Business Practice Location Address:
SUITE #310
Provider Business Practice Location Address City Name:
CANOGA PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91303-3159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-347-8565
Provider Business Practice Location Address Fax Number:
818-347-0506
Provider Enumeration Date:
01/04/2011