Provider First Line Business Practice Location Address:
9535 RESEDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 313
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-6030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-885-7230
Provider Business Practice Location Address Fax Number:
818-885-7277
Provider Enumeration Date:
08/04/2010