Provider First Line Business Practice Location Address:
8300 TAMPA AVE
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-4267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-718-6080
Provider Business Practice Location Address Fax Number:
718-625-1559
Provider Enumeration Date:
02/13/2015