Provider First Line Business Practice Location Address:
12158 HAMLIN ST
Provider Second Line Business Practice Location Address:
SUITE # 6
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-761-1445
Provider Business Practice Location Address Fax Number:
818-761-2189
Provider Enumeration Date:
12/24/2008