Provider First Line Business Practice Location Address:
8843 NEWCASTLE AVE
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:
91325-3151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-237-6494
Provider Business Practice Location Address Fax Number:
818-349-6617
Provider Enumeration Date:
01/23/2011