Provider First Line Business Practice Location Address:
8632 BALBOA BLVD
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:
91325-3505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-894-6161
Provider Business Practice Location Address Fax Number:
818-894-6001
Provider Enumeration Date:
04/17/2007