Provider First Line Business Practice Location Address:
16921 PARTHENIA ST.
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91343-4559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-893-8883
Provider Business Practice Location Address Fax Number:
818-893-9889
Provider Enumeration Date:
07/01/2011