Provider First Line Business Practice Location Address:
18200 CHATSWORTH 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:
91326-3208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-581-7938
Provider Business Practice Location Address Fax Number:
310-683-0218
Provider Enumeration Date:
09/21/2023