Provider First Line Business Practice Location Address:
17657 LEMARSH 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:
91325-1412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-832-7352
Provider Business Practice Location Address Fax Number:
818-832-7253
Provider Enumeration Date:
03/27/2007