Provider First Line Business Practice Location Address:
8901 GLADBECK AVE
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:
91324-3908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-472-9927
Provider Business Practice Location Address Fax Number:
818-998-3890
Provider Enumeration Date:
12/14/2009