Provider First Line Business Practice Location Address:
9900 BALBOA BLVD STE E
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:
91325-5419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-701-0017
Provider Business Practice Location Address Fax Number:
818-701-0073
Provider Enumeration Date:
12/03/2009