Provider First Line Business Practice Location Address:
9671 RESEDA 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:
91324-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-345-5556
Provider Business Practice Location Address Fax Number:
818-960-6925
Provider Enumeration Date:
01/06/2023