Provider First Line Business Practice Location Address:
9720 RESEDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-5515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-349-5441
Provider Business Practice Location Address Fax Number:
818-349-5452
Provider Enumeration Date:
10/05/2006