Provider First Line Business Practice Location Address:
8330 RESEDA 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:
91324-4619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
181-853-4182
Provider Business Practice Location Address Fax Number:
818-936-0108
Provider Enumeration Date:
12/27/2006