Provider First Line Business Practice Location Address:
11239 TAMPA AVE
Provider Second Line Business Practice Location Address:
SUITE #201
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-368-3705
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006