Provider First Line Business Practice Location Address:
5032 LANKERSHIM BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91601-4245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-508-9888
Provider Business Practice Location Address Fax Number:
818-508-9884
Provider Enumeration Date:
04/17/2008