Provider First Line Business Practice Location Address:
9348 MCLENNAN 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:
91343-2722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-925-1482
Provider Business Practice Location Address Fax Number:
818-924-9800
Provider Enumeration Date:
04/23/2009