Provider First Line Business Practice Location Address:
17042 DEVONSHIRE ST
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325-1679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-831-8270
Provider Business Practice Location Address Fax Number:
818-831-8272
Provider Enumeration Date:
05/24/2005