Provider First Line Business Practice Location Address:
16707 LABRADOR 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:
91343-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-661-0874
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2026