Provider First Line Business Practice Location Address:
18350 ROSCOE BLVD.
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325-4148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-993-4471
Provider Business Practice Location Address Fax Number:
818-993-7565
Provider Enumeration Date:
07/05/2006