Provider First Line Business Practice Location Address:
6005 VINELAND AVE
Provider Second Line Business Practice Location Address:
SUITE 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:
91606-4981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-506-5400
Provider Business Practice Location Address Fax Number:
818-506-5430
Provider Enumeration Date:
06/26/2008