Provider First Line Business Practice Location Address:
10150 ALDEA AVE
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:
91325-1547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-400-2297
Provider Business Practice Location Address Fax Number:
818-743-0695
Provider Enumeration Date:
12/20/2010