Provider First Line Business Practice Location Address:
9909 BOTHWELL RD
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:
91324-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-998-1818
Provider Business Practice Location Address Fax Number:
818-998-8282
Provider Enumeration Date:
10/18/2013