Provider First Line Business Practice Location Address:
19500 PLUMMER ST UNIT D3
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:
91324-2153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-341-1150
Provider Business Practice Location Address Fax Number:
818-341-1155
Provider Enumeration Date:
05/13/2010