Provider First Line Business Practice Location Address:
18300 ROSCOE BLVD.
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:
91328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-885-5440
Provider Business Practice Location Address Fax Number:
818-885-5497
Provider Enumeration Date:
10/23/2009