Provider First Line Business Practice Location Address:
16909 PARTHENIA ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91343-4551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-810-6153
Provider Business Practice Location Address Fax Number:
818-810-6023
Provider Enumeration Date:
01/15/2014