Provider First Line Business Practice Location Address:
8833 RESEDA BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-5353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-341-0670
Provider Business Practice Location Address Fax Number:
818-341-0690
Provider Enumeration Date:
11/04/2005