Provider First Line Business Practice Location Address:
18406 ROSCOE BLVD STE A
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:
91325-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-700-5678
Provider Business Practice Location Address Fax Number:
818-700-2388
Provider Enumeration Date:
12/08/2006