Provider First Line Business Practice Location Address:
18529 ROSCOE BLVD
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:
91324-4632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-727-7222
Provider Business Practice Location Address Fax Number:
818-727-1624
Provider Enumeration Date:
10/10/2006