Provider First Line Business Practice Location Address:
18509 SAN FERNANDO MISSION BLVD
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:
91326-2434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-366-2483
Provider Business Practice Location Address Fax Number:
818-363-5770
Provider Enumeration Date:
01/31/2013