Provider First Line Business Practice Location Address:
18539 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:
91324-4632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-578-0111
Provider Business Practice Location Address Fax Number:
818-578-0222
Provider Enumeration Date:
03/13/2025