Provider First Line Business Practice Location Address:
9801 BALBOA BL
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-886-6100
Provider Business Practice Location Address Fax Number:
818-886-5207
Provider Enumeration Date:
04/24/2014