Provider First Line Business Practice Location Address:
16861 PARTHENIA 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:
91343-4539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-988-4430
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2018