Provider First Line Business Practice Location Address:
8842 QUAKERTOWN 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:
91324-3230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-917-0534
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2026