Provider First Line Business Practice Location Address:
11145 TAMPA AVE STE 23A
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:
91326-2271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-787-1242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2011