Provider First Line Business Practice Location Address:
16933 PARTHENIA ST STE 112
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:
91343-4570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-341-5433
Provider Business Practice Location Address Fax Number:
818-341-5439
Provider Enumeration Date:
04/20/2007