Provider First Line Business Practice Location Address:
16921 PARTHENIA ST STE 201B
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:
91343-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-387-6048
Provider Business Practice Location Address Fax Number:
818-387-6237
Provider Enumeration Date:
02/09/2022