Provider First Line Business Practice Location Address:
6400 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
SUITE # 600
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606-1559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-760-0501
Provider Business Practice Location Address Fax Number:
818-763-3890
Provider Enumeration Date:
08/23/2006