Provider First Line Business Practice Location Address:
18531 ROSCOE BLVD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-4641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-772-1280
Provider Business Practice Location Address Fax Number:
818-772-6546
Provider Enumeration Date:
11/08/2006