Provider First Line Business Practice Location Address:
18300 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:
91325-4105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-885-8500
Provider Business Practice Location Address Fax Number:
818-715-1722
Provider Enumeration Date:
03/28/2006