Provider First Line Business Practice Location Address:
5050 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:
91601-4225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-284-4155
Provider Business Practice Location Address Fax Number:
818-505-8578
Provider Enumeration Date:
07/14/2008