Provider First Line Business Practice Location Address:
8350 RESEDA BLVD STE 101
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:
91324-4619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-848-9771
Provider Business Practice Location Address Fax Number:
323-650-0824
Provider Enumeration Date:
12/19/2006