Provider First Line Business Practice Location Address:
19843 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:
91324-3331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-783-1425
Provider Business Practice Location Address Fax Number:
818-995-0901
Provider Enumeration Date:
10/27/2009