Provider First Line Business Practice Location Address:
8833 RESEDA BLVD STE D
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:
91324-5356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-727-2626
Provider Business Practice Location Address Fax Number:
818-727-2625
Provider Enumeration Date:
06/20/2006