Provider First Line Business Practice Location Address:
9250 RESEDA BLVD STE 2C
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:
91324-5215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-701-7777
Provider Business Practice Location Address Fax Number:
818-700-4510
Provider Enumeration Date:
01/23/2008