Provider First Line Business Practice Location Address:
16645 VINTAGE 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:
91343-1152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-366-1390
Provider Business Practice Location Address Fax Number:
818-698-0444
Provider Enumeration Date:
07/07/2006