Provider First Line Business Practice Location Address:
18497 DEARBORN ST
Provider Second Line Business Practice Location Address:
UNIT 112
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-851-8351
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2019