Provider First Line Business Practice Location Address:
5016 LANKERSHIM BLVD
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:
91601-4222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-762-3155
Provider Business Practice Location Address Fax Number:
818-762-3157
Provider Enumeration Date:
06/11/2008