Provider First Line Business Practice Location Address:
18406 ROSCO BLVD
Provider Second Line Business Practice Location Address:
NORTHRIDGE FAMILY PRACTICE MEDICAL GROUP INC
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-885-5480
Provider Business Practice Location Address Fax Number:
818-993-1917
Provider Enumeration Date:
10/19/2006