Provider First Line Business Practice Location Address:
18822 1/2 CHASE 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:
91324-4512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-521-1694
Provider Business Practice Location Address Fax Number:
818-818-5095
Provider Enumeration Date:
09/11/2021