Provider First Line Business Practice Location Address:
18251 ROSCOE BLVD
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-885-7611
Provider Business Practice Location Address Fax Number:
818-885-8236
Provider Enumeration Date:
12/29/2010