Provider First Line Business Practice Location Address:
9900 BALBOA BLVD.
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-701-7070
Provider Business Practice Location Address Fax Number:
818-993-9900
Provider Enumeration Date:
05/07/2007