Provider First Line Business Practice Location Address:
9659 BALBOA 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:
91325-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-349-1401
Provider Business Practice Location Address Fax Number:
818-988-5474
Provider Enumeration Date:
12/31/2006