Provider First Line Business Practice Location Address:
8223 LOUISE 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:
91325-4449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-245-1325
Provider Business Practice Location Address Fax Number:
213-772-6870
Provider Enumeration Date:
09/23/2022