Provider First Line Business Practice Location Address:
18627 KNAPP ST
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:
91324-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-308-8987
Provider Business Practice Location Address Fax Number:
747-202-3604
Provider Enumeration Date:
07/09/2025