Provider First Line Business Practice Location Address:
18711 PARTHENIA ST UNIT 2
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:
91324-3845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-349-0049
Provider Business Practice Location Address Fax Number:
818-349-0048
Provider Enumeration Date:
12/22/2015