Provider First Line Business Practice Location Address:
9153 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:
91324-3031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-701-0123
Provider Business Practice Location Address Fax Number:
818-701-1762
Provider Enumeration Date:
02/07/2006