Provider First Line Business Practice Location Address:
8700 RESEDA BLVD.
Provider Second Line Business Practice Location Address:
UNIT 107
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:
818-998-9905
Provider Business Practice Location Address Fax Number:
818-998-9906
Provider Enumeration Date:
09/26/2006