Provider First Line Business Practice Location Address:
11200 CORBIN AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-831-8252
Provider Business Practice Location Address Fax Number:
818-831-8255
Provider Enumeration Date:
11/01/2006