Provider First Line Business Practice Location Address:
8600 MELVIN AVE
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:
91324-4137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-270-7659
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2025