Provider First Line Business Practice Location Address:
9150 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-801-4129
Provider Business Practice Location Address Fax Number:
310-966-1175
Provider Enumeration Date:
12/12/2008