Provider First Line Business Practice Location Address:
8345 RESEDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-882-2934
Provider Business Practice Location Address Fax Number:
818-832-5828
Provider Enumeration Date:
01/25/2007