Provider First Line Business Practice Location Address:
6734 LANKERSHIM BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606-1615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-762-1270
Provider Business Practice Location Address Fax Number:
818-726-1275
Provider Enumeration Date:
06/28/2006