Provider First Line Business Practice Location Address:
18441 BRYANT 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:
91325-3309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-993-5441
Provider Business Practice Location Address Fax Number:
818-993-4311
Provider Enumeration Date:
09/25/2006