Provider First Line Business Practice Location Address:
17300 ROSCOE 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:
91325-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-344-2042
Provider Business Practice Location Address Fax Number:
818-344-1892
Provider Enumeration Date:
03/19/2012