Provider First Line Business Practice Location Address:
9010 CORBIN AVE STE 4
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:
91324-3392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-770-6147
Provider Business Practice Location Address Fax Number:
213-232-1008
Provider Enumeration Date:
10/28/2021