Provider First Line Business Practice Location Address:
4942 VINELAND AVE
Provider Second Line Business Practice Location Address:
UNIT C
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91601-5637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-821-3431
Provider Business Practice Location Address Fax Number:
818-821-3441
Provider Enumeration Date:
05/23/2013