Provider First Line Business Practice Location Address:
18519 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:
91324-4632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-626-8955
Provider Business Practice Location Address Fax Number:
818-626-9536
Provider Enumeration Date:
07/10/2006