Provider First Line Business Practice Location Address:
9514 RESEDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-775-1300
Provider Business Practice Location Address Fax Number:
818-775-1465
Provider Enumeration Date:
12/29/2006