Provider First Line Business Practice Location Address:
8550 BALBOA BLVD
Provider Second Line Business Practice Location Address:
SUITE 216
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:
661-414-2565
Provider Business Practice Location Address Fax Number:
818-739-5185
Provider Enumeration Date:
09/03/2013