Provider First Line Business Practice Location Address:
8811 SHIRLEY AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-718-2811
Provider Business Practice Location Address Fax Number:
818-718-5876
Provider Enumeration Date:
03/23/2006