Provider First Line Business Practice Location Address:
17300 NORDHOFF 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:
91325-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-886-0991
Provider Business Practice Location Address Fax Number:
818-885-8461
Provider Enumeration Date:
08/22/2006