Provider First Line Business Practice Location Address:
8331 RESEDA 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:
91324-4620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-724-5979
Provider Business Practice Location Address Fax Number:
818-975-5424
Provider Enumeration Date:
10/21/2016