Provider First Line Business Practice Location Address:
9221 CORBIN AVE STE 150
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:
91324-2482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-339-6093
Provider Business Practice Location Address Fax Number:
818-688-0399
Provider Enumeration Date:
08/01/2025