Provider First Line Business Practice Location Address:
18406 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:
91325-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-885-5480
Provider Business Practice Location Address Fax Number:
818-727-0793
Provider Enumeration Date:
03/27/2013