Provider First Line Business Practice Location Address:
9301 TAMPA AVE
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:
91324-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-885-7300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2009