Provider First Line Business Practice Location Address:
19115 HARNETT 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:
91326-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-730-9309
Provider Business Practice Location Address Fax Number:
626-813-3720
Provider Enumeration Date:
06/14/2006