Provider First Line Business Practice Location Address:
16714 PARTHENIA ST
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:
91343-4609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-891-2273
Provider Business Practice Location Address Fax Number:
323-654-2104
Provider Enumeration Date:
09/24/2014