Provider First Line Business Practice Location Address:
8510 BALBOA BLVD
Provider Second Line Business Practice Location Address:
SUTIE 150
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325-3583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-552-6230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2005