Provider First Line Business Practice Location Address:
8903 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:
91325-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-894-9301
Provider Business Practice Location Address Fax Number:
818-894-8841
Provider Enumeration Date:
04/20/2007