Provider First Line Business Practice Location Address:
184332 ROSCOE BLVD.
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-734-7620
Provider Business Practice Location Address Fax Number:
818-734-7621
Provider Enumeration Date:
07/21/2006