Provider First Line Business Practice Location Address:
19871 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:
818-349-5050
Provider Business Practice Location Address Fax Number:
818-349-5052
Provider Enumeration Date:
05/22/2013