Provider First Line Business Practice Location Address:
11413 MOORPARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUDIO CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91602-2009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-506-6696
Provider Business Practice Location Address Fax Number:
818-506-6693
Provider Enumeration Date:
12/01/2006