Provider First Line Business Practice Location Address:
17632 PARTHENIA 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:
91325-3159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-568-1241
Provider Business Practice Location Address Fax Number:
818-812-9018
Provider Enumeration Date:
12/10/2009