Provider First Line Business Practice Location Address:
8819 RESEDA BLVD STE 2
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:
91324-5361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-993-8433
Provider Business Practice Location Address Fax Number:
818-993-7598
Provider Enumeration Date:
01/16/2007