Provider First Line Business Practice Location Address:
8700 RESEDA BLVD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-4041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-885-5503
Provider Business Practice Location Address Fax Number:
818-885-5750
Provider Enumeration Date:
12/07/2011