Provider First Line Business Practice Location Address:
191 S. BUENA VISTA STREET,
Provider Second Line Business Practice Location Address:
SUITE #215 LAKESIDE COMMUNITY HEALTHCARE
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91505-4505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-295-6944
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2012