Provider First Line Business Practice Location Address:
6736 LAUREL CANYOUN BLVD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-755-8786
Provider Business Practice Location Address Fax Number:
818-755-8789
Provider Enumeration Date:
03/29/2007