Provider First Line Business Practice Location Address:
5816 LANKERSHIM BLVD
Provider Second Line Business Practice Location Address:
STE. 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:
91601-1671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-719-9628
Provider Business Practice Location Address Fax Number:
818-760-1945
Provider Enumeration Date:
06/10/2006