Provider First Line Business Practice Location Address:
19205 PARTHENIA ST STE A
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:
91324-5151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-200-9350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2021