Provider First Line Business Practice Location Address:
19100 PARTHENIA ST #1,2,3,4 6, AND 7
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:
91324-3664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-739-5125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2014