Provider First Line Business Practice Location Address:
10237 MELVIN 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:
91324-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-395-5663
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2023