Provider First Line Business Practice Location Address:
11650 RIVERSIDE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-980-1221
Provider Business Practice Location Address Fax Number:
818-980-3221
Provider Enumeration Date:
07/09/2008