Provider First Line Business Practice Location Address:
8949 RESEDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 224
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-341-9556
Provider Business Practice Location Address Fax Number:
818-341-9528
Provider Enumeration Date:
07/30/2012