Provider First Line Business Practice Location Address:
18327 NAPA 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:
91325-3617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-717-8807
Provider Business Practice Location Address Fax Number:
818-717-0910
Provider Enumeration Date:
01/20/2011