Provider First Line Business Practice Location Address:
19169 LAHEY ST UNIT 3
Provider Second Line Business Practice Location Address:
STE. 3
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91326-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-516-7786
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2015