Provider First Line Business Practice Location Address:
18444 PLUMMER STREET
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:
91325-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-349-6267
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006