Provider First Line Business Practice Location Address:
8956 CORBIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-3311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-885-1954
Provider Business Practice Location Address Fax Number:
818-885-0138
Provider Enumeration Date:
08/31/2006