Provider First Line Business Practice Location Address:
18300 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:
91328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-885-8500
Provider Business Practice Location Address Fax Number:
818-700-5690
Provider Enumeration Date:
05/05/2017