Provider First Line Business Practice Location Address:
9545 RESEDA BLVD STE 4
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:
818-886-2005
Provider Business Practice Location Address Fax Number:
818-886-8165
Provider Enumeration Date:
08/21/2006