Provider First Line Business Practice Location Address:
9301 LASAINE 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:
91325-2421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-357-8301
Provider Business Practice Location Address Fax Number:
888-428-6138
Provider Enumeration Date:
02/18/2021