Provider First Line Business Practice Location Address:
10178 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:
91324-1487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-775-1200
Provider Business Practice Location Address Fax Number:
818-775-5789
Provider Enumeration Date:
09/14/2017