Provider First Line Business Practice Location Address:
9700 RESEDA BLVD.
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-5505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-349-9040
Provider Business Practice Location Address Fax Number:
818-701-7795
Provider Enumeration Date:
07/03/2007