Provider First Line Business Practice Location Address:
6444 BELLINGHAM AVE.
Provider Second Line Business Practice Location Address:
STE. 204
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-509-8744
Provider Business Practice Location Address Fax Number:
818-337-2967
Provider Enumeration Date:
05/03/2007