Provider First Line Business Practice Location Address:
8217 LANKERSHIM BLVD STE 29
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91605-0937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-767-7003
Provider Business Practice Location Address Fax Number:
818-767-1781
Provider Enumeration Date:
10/04/2006