Provider First Line Business Practice Location Address:
19346 NORDHOFF 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:
91324-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-727-2040
Provider Business Practice Location Address Fax Number:
818-727-2090
Provider Enumeration Date:
06/04/2019