Provider First Line Business Practice Location Address:
4648 LANKERSHIM BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91602-1836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-505-0520
Provider Business Practice Location Address Fax Number:
818-506-6271
Provider Enumeration Date:
03/01/2010