Provider First Line Business Practice Location Address:
4640 LANKERSHIM BLVD STE 110
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:
91602-1848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
187-632-7288
Provider Business Practice Location Address Fax Number:
888-453-0513
Provider Enumeration Date:
06/22/2011